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Feyzioğlu Ö, Dinçer S, Özdemir AE, Öztürk Ö. Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer. Disabil Rehabil 2024:1-8. [PMID: 38613370 DOI: 10.1080/09638288.2024.2340703] [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: 08/11/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. METHODS This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. RESULTS All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. CONCLUSIONS The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.
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Affiliation(s)
- Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ayşem Ecem Özdemir
- Department of Physiotherapy and Rehabilitation, Gelisim University, Faculty of Health Sciences, Istanbul, Turkey
| | - Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
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Paal K, Stranz B, Thurner EM, Langsenlehner U, Renner W, Brunner TB, Langsenlehner T. Comprehensive geriatric assessment predicts radiation-induced acute toxicity in prostate cancer patients. Strahlenther Onkol 2024; 200:208-218. [PMID: 37658924 PMCID: PMC10876759 DOI: 10.1007/s00066-023-02132-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of the present prospective study was to evaluate the significance of geriatric conditions measured by a comprehensive geriatric assessment (GA) for the prediction of the risk of high-grade acute radiation-induced toxicity. METHODS A total of 314 prostate cancer patients (age ≥ 65 years) undergoing definitive radiotherapy at a tertiary academic center were included. Prior to treatment, patients underwent a GA. High-grade toxicity was defined as acute toxicity grade ≥ 2 according to standard RTOG/EORTC criteria. To analyze the predictive value of the GA, univariable and multivariable logistic regression models were applied. RESULTS A total of 40 patients (12.7%) developed acute toxicity grade ≥ 2; high grade genitourinary was found in 37 patients (11.8%) and rectal toxicity in 8 patients (2.5%), respectively. Multivariable analysis revealed a significant association of comorbidities with overall toxicity grade ≥ 2 (odds ratio [OR] 2.633, 95% confidence interval [CI] 1.260-5.502; p = 0.010) as well as with high-grade genitourinary and rectal toxicity (OR 2.169, 95%CI1.017-4.625; p = 0.045 and OR 7.220, 95%CI 1.227-42.473; p = 0.029, respectively). Furthermore, the Activities of Daily Living score (OR 0.054, 95%CI 0.004-0.651; p = 0.022), social status (OR 0.159, 95%CI 0.028-0.891; p = 0.036), and polypharmacy (OR 4.618, 95%CI 1.045-20.405; p = 0.044) were identified as independent predictors of rectal toxicity grade ≥ 2. CONCLUSION Geriatric conditions seem to be predictive of the development of high-grade radiation-induced toxicity in prostate cancer patients treated with definitive radiotherapy.
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Affiliation(s)
- Katarzyna Paal
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Bettina Stranz
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Eva-Maria Thurner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Uwe Langsenlehner
- Outpatient Center for Internal Medicine, PRODOCplus, 8020, Graz, Austria
| | - Wilfried Renner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036, Graz, Austria
| | - Thomas Baptist Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Tanja Langsenlehner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria.
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Oudard S, Ratta R, Voog E, Barthelemy P, Thiery-Vuillemin A, Bennamoun M, Hasbini A, Aldabbagh K, Saldana C, Sevin E, Amela E, Von Amsberg G, Houede N, Besson D, Feyerabend S, Boegemann M, Pfister D, Schostak M, Huillard O, Di Fiore F, Quivy A, Lange C, Phan L, Belhouari H, Tran Y, Kotti S, Helissey C. Biweekly vs Triweekly Cabazitaxel in Older Patients With Metastatic Castration-Resistant Prostate Cancer: The CABASTY Phase 3 Randomized Clinical Trial. JAMA Oncol 2023; 9:1629-1638. [PMID: 37883073 PMCID: PMC10603579 DOI: 10.1001/jamaoncol.2023.4255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/07/2023] [Indexed: 10/27/2023]
Abstract
Importance Many patients 65 years or older with metastatic castration-resistant prostate cancer (mCRPC) are denied taxane chemotherapy because this treatment is considered unsuitable. Objective To determine whether biweekly cabazitaxel (CBZ), 16 mg/m2 (biweekly CBZ16), plus prophylactic granulocyte colony-stimulating factor (G-CSF) at each cycle reduces the risk of grade 3 or higher neutropenia and/or neutropenic complications (eg, febrile neutropenia, neutropenic infection, or sepsis) compared with triweekly CBZ, 25 mg/m2 (triweekly CBZ25), plus G-CSF (standard regimen). Design, Setting, and Participants A total of 196 patients 65 years or older with progressive mCRPC were enrolled in this prospective phase 3 randomized clinical trial conducted in France (18 centers) and Germany (7 centers) between May 5, 2017, and January 7, 2021. All patients had received docetaxel and at least 1 novel androgen receptor-targeted agent. Interventions Patients were randomly assigned 1:1 to receive biweekly CBZ16 plus G-CSF and daily prednisolone (experimental group) or triweekly CBZ25 plus G-CSF and daily prednisolone (control group). Main Outcome and Measures The primary end point was the occurrence of grade 3 or higher neutropenia measured at nadir and/or neutropenic complications. Results Among 196 patients (97 in the triweekly CBZ25 group and 99 in the biweekly CBZ16 group), the median (IQR) age was 74.6 (70.4-79.3) years, and 181 (92.3%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. The median (IQR) follow-up duration was 31.3 (22.5-37.5) months. Relative dose intensities were comparable between groups (median [IQR], 92.7% [83.7%-98.9%] in the triweekly CBZ25 group vs 92.8% [87.0%-98.9%] in the biweekly CBZ16 group). The rate of grade 3 or higher neutropenia and/or neutropenic complications was significantly higher with triweekly CBZ25 vs biweekly CBZ16 (60 of 96 [62.5%] vs 5 of 98 [5.1%]; odds ratio, 0.03; 95% CI, 0.01-0.08; P < .001). Grade 3 or higher adverse events were more common with triweekly CBZ25 (70 of 96 [72.9%]) vs biweekly CBZ16 (55 of 98 [56.1%]). One patient (triweekly CBZ25 group) died of a neutropenic complication. Conclusions and Relevance In this randomized clinical trial, compared with the standard regimen, biweekly CBZ16 plus G-CSF significantly reduced by 12-fold the occurrence of grade 3 or higher neutropenia and/or neutropenic complications, with comparable clinical outcomes. The findings suggest that biweekly CBZ16 regimen should be offered to patients 65 years or older with mCRPC for whom the standard regimen is unsuitable. Trial Registration ClinicalTrials.gov Identifier: NCT02961257.
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Affiliation(s)
- Stéphane Oudard
- Oncology Department, Hopital European Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Cité, Paris, France
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
| | | | - Eric Voog
- Oncology Department, Jean Bernard Center, Le Mans, France
| | - Philippe Barthelemy
- Oncology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | | | | | - Ali Hasbini
- Oncology Department, Clinique Pasteur Lanroze, Brest, France
| | - Kais Aldabbagh
- Oncology Department, Polyclinique Saint Côme, Compiègne, France
| | - Carolina Saldana
- Oncology Department, Henri Mondor Hospital, Paris Est Créteil University, Therapeutic Resistance in Prostate Cancer, Créteil, France
| | - Emmanuel Sevin
- Oncology Department, Centre Maurice Tubiana, Caen, France
| | - Eric Amela
- Oncology Department, Centre de Cancérologie Les Dentellières, Valenciennes, France
| | - Gunhild Von Amsberg
- Department of Oncology, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Houede
- Oncology Department, Institut de Cancérologie du Gard, CHU de Nîmes, Montpellier University, France
| | - Dominique Besson
- Oncology Department, Centre Armoricain de Radiothérapie et d’Oncologie, Plérin, France
| | - Susan Feyerabend
- Studienpraxis Urologie, Studienpraxis Urologie, Nürtingen, Germany
| | - Martin Boegemann
- Urology Department, Universitätsklinikum Münster, University Hospital Münster, Münster, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology and Robot-Assisted Surgery, University Hospital of Cologne, Cologne, Germany
| | - Martin Schostak
- Department of Urology, Uro-Oncology and Robot-Assisted and Focal Therapy, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | | | - Frederic Di Fiore
- Uro-Digestive Oncology Unit, Rouen University Hospital, Rouen, France
| | - Amandine Quivy
- Oncology Department, Saint André Hospital, Bordeaux, France
| | | | - Letuan Phan
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
| | - Houda Belhouari
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
| | - Yohann Tran
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
| | - Salma Kotti
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, Paris, France
| | - Carole Helissey
- Oncology Department, Military Hospital Begin, Saint-Mandé, France
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Piringer G, Thaler J, Anchisi S, Geffriaud-Ricouard C, Gueldner M, Scholten F, Derigs HG, Bohanes P, Grünberger B, Schwarz L, von Moos R, Hofheinz RD. Quality of life, effectiveness, and safety of aflibercept plus FOLFIRI in older patients with metastatic colorectal cancer: An analysis of the prospective QoLiTrap study. J Geriatr Oncol 2023; 14:101638. [PMID: 37776611 DOI: 10.1016/j.jgo.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) mainly affects older patients. The pivotal VELOUR phase III trial of aflibercept plus FOLFIRI in metastatic CRC (mCRC) included only 5.9% of patients aged ≥75 years. Herein, we report a preplanned analysis from QoLiTrap, a large prospective observational study evaluating the impact of age on quality of life (QoL), effectiveness, and safety of aflibercept plus FOLFIRI in daily clinical practice in Europe. MATERIALS AND METHODS Enrolled patients had progressive mCRC, had failed a prior oxaliplatin-based regimen, and had received aflibercept (4 mg/kg) plus FOLFIRI every two weeks until disease progression, death, unacceptable toxicity, or physician/patient decision. Analyses were performed by age classes (<60, 60-64, 65-69, 70-74, and ≥ 75 years). The primary endpoint was the percentage of patients whose global health status (GHS) of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was maintained (i.e., no worsening from baseline by at least 5% over a 12-week treatment). Secondary endpoints included tumor objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS Overall, 1277 patients (<60 years, n = 327; 60-64 years, n = 231; 65-69 years, n = 227; 70-74 years, n = 259; and ≥ 75 years, n = 233) were treated, of whom 872 were evaluable for QoL. GHS was maintained in 36.5%, 41.6%, 38.9%, 41.8%, and 44.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. Age did not influence PFS (median 7.8 months), OS (median 14.4 months), or ORR (20.8%). Number of cycles, dose delays for any cause, and dose reductions for adverse events (AEs) were comparable between age classes. Grade ≥ 3 AEs occurred in 47.7%, 51.9%, 51.5%, 55.2%, and 55.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. The main grade ≥ 3 AEs were hypertension (11.2%) and diarrhea (9%) in patients aged ≥75 years. DISCUSSION The results suggest that aflibercept plus FOLFIRI maintains QoL and retains its activity, including a high objective tumor response, regardless of age and treatment line. In fit older patients, the safety profile seems manageable, with no new safety signals.
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Affiliation(s)
- Gudrun Piringer
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria; Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Sandro Anchisi
- Department of Oncology, Valais Romand Hospital Center, Valais Hospital, Av. Grand-Champsec 86, 1951 Sion, Switzerland
| | | | - Max Gueldner
- Sanofi-Aventis Deutschland GmbH, Luetzowstraße 107, 10785 Berlin, Germany
| | - Felicitas Scholten
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Hans-Günter Derigs
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Pierre Bohanes
- Department of Oncology and Internal Medicine, Center for Chemotherapy, 1004 Lausanne, Switzerland
| | - Birgit Grünberger
- Department of Internal Medicine, Hematology and Oncology, Hospital Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Leonora Schwarz
- Department of Biometry, Alcedis, Winchesterstr 3, 35394 Giessen, Germany
| | - Roger von Moos
- Department of Oncology, Cantonal Hospital Graubuenden, Loestrasse 170, 7000 Chur, Switzerland
| | - Ralf-Dieter Hofheinz
- Department of Oncology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany.
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Tauber R, Knorr K, Retz M, Rauscher I, Grigorascu S, Hansen K, D'Alessandria C, Wester HJ, Gschwend J, Weber W, Eiber M, Langbein T. Safety and Efficacy of [ 177Lu]-PSMA-I&T Radioligand Therapy in Octogenarians with Metastatic Castration-Resistant Prostate Cancer: Report on 80 Patients over the Age of 80 Years. J Nucl Med 2023:jnumed.122.265259. [PMID: 37321824 DOI: 10.2967/jnumed.122.265259] [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: 12/06/2022] [Revised: 03/14/2023] [Indexed: 06/17/2023] Open
Abstract
177Lu-labeled prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) is a new treatment option for metastatic castration-resistant prostate cancer (mCRPC). Its low toxicity profile favors use in elderly patients or in patients with critical comorbidities. The purpose of this analysis was to evaluate the efficacy and safety of [177Lu]-PSMA RLT in mCRPC patients at least 80 y old. Methods: Eighty mCRPC patients at least 80 y old underwent [177Lu]-PSMA-I&T RLT and were retrospectively selected. The patients were previously treated by androgen receptor-directed therapy, received taxane-based chemotherapy, or were chemotherapy-ineligible. The best prostate-specific antigen (PSA) response was calculated, as well as clinical progression-free survival (cPFS) and overall survival (OS). Toxicity data were acquired until 6 mo after the last treatment cycle. Results: Of 80 patients, 49 (61.3%) were chemotherapy-naïve and 16 (20%) had visceral metastases. The median number of previous mCRPC treatment regimens was 2. In total, 324 cycles (median, 4 cycles; range, 1-12) with a median cumulative activity of 23.8 GBq (interquartile range, 14.8-42.2) were applied. A PSA decline of 50% was achieved in 37 (46.3%) patients. Chemotherapy-naïve patients showed higher 50% PSA response rates than chemotherapy-pretreated patients (51.0% vs. 38.7%, respectively). Overall, median cPFS and OS were 8.7 and 16.1 mo, respectively. The median cPFS and OS of chemotherapy-naïve patients were significantly longer than those of chemotherapy-pretreated patients (10.5 vs. 6.5 mo and 20.7 vs. 11.8 mo, respectively, P < 0.05). A lower hemoglobin level and higher lactate dehydrogenase level at baseline were independent predictors of shorter cPFS and OS. Treatment-emergent grade 3 toxicities were anemia in 4 patients (5%), thrombocytopenia in 3 patients (3.8%), and renal impairment in 4 patients (5%). No nonhematologic grade 3 and no grade 4 toxicities were observed. The most frequent clinical side effects were grade 1-2 xerostomia, fatigue, and inappetence. Conclusion: [177Lu]-PSMA-I&T RLT in mCRPC patients at least 80 y old is safe and effective, comparable to previously published data on non-age-selected cohorts with a low rate of high-grade toxicities. Chemotherapy-naïve patients showed a better and longer response to therapy than taxane-pretreated patients. [177Lu]-PSMA RLT seems to be a meaningful treatment option for older patients.
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Affiliation(s)
- Robert Tauber
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany;
| | - Karina Knorr
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Margitta Retz
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Sonia Grigorascu
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Kimberley Hansen
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Calogero D'Alessandria
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | | | - Jürgen Gschwend
- Department of Urology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Thomas Langbein
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; and
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Bouzan J, Nellas S, Stoilkov B, Willschrei P, Horstmann M. Item analysis of G8 screening in uro-oncologic geriatric patients. Int Urol Nephrol 2023; 55:1441-1446. [PMID: 37067702 DOI: 10.1007/s11255-023-03594-1] [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: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION/BACKGROUND The G8 score is a widespread screening tool for geriatric frailty in oncology. The aim of this study was to evaluate the scores and relevance of G8 items in a standard screening of geriatric patients with uro-oncologic diseases to better understand the results of the assessment. METHODS Eighty-two consecutive uro-oncologic geriatric patients aged 75 years and older were evaluated. All patients underwent a G8 screening that consisted of 8 items. Patients with a G8 score above 14 were considered geriatric "fit", while others were considered to be "frail". Overall results and single item scores were evaluated. Clinical data were gathered from patients' charts. RESULTS The mean age of the patients was 82 years (min. 75-max. 102). In 36 of the patients, the G8 score indicated "no-frailty", and in 46 patients, the G8 score indicated "frailty". The mean G8 score was 12.9 (min 4-max 17 pts). Item analysis revealed that points were most often lost in items H (polypharmacy), P (comparison of health status to peers) and Age. Fifty-nine, 56 and 52 patients lost points on item Age, item H and item P, respectively. In contrast, the majority of patients reached the maximum score for nutritional items [i.e., items A (food intake), B (weight loss) and F (body mass index (BMI))]. For item A, 73 patients reached the maximum score; for item B, 62 patients reached the maximum score; and for item F, 72 patients reached the maximum score. There were no differences in this distribution pattern when comparing tumour entities, sex, and patients with local vs. metastatic disease. CONCLUSION The present study revealed a high percentage of suspicious test results. Potential reasons for these findings include the low threshold of the G8 overall score and the fact that in some items, points were easily lost. Modifications of the test should be considered.
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Affiliation(s)
- J Bouzan
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S Nellas
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - B Stoilkov
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - P Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276, Essen, Germany
| | - M Horstmann
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany.
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332, Gütersloh, Germany.
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7
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Analysis of Frailty Syndrome in Men with Metastatic Prostate Cancer: A Scoping Review. J Pers Med 2023; 13:jpm13020319. [PMID: 36836553 PMCID: PMC9964735 DOI: 10.3390/jpm13020319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Most patients with metastatic prostate cancer (mPCa) are older. In addition, current geriatric oncology guidelines suggest that all cancer patients aged over 70 years should undergo a comprehensive geriatric assessment (CGA), with the identification of frailty syndrome being crucial for clinical decisions. Frailty can be associated with lower quality of life (QoL) and interfere with the feasibility or side effects of oncology treatments. METHODS We performed a systematic literature search to evaluate frailty syndrome and associated alterations related to CGA impairment by searching in different academic databases (PubMed, Embase, and Scopus). The identified articles were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 165 articles consulted, 7 met our inclusion criteria. Analysis of data related to frailty syndrome in patients with mPCa showed a prevalence between 30-70% depending on the tool used. Additionally, frailty was associated with other CGA assessments and QoL evaluation outcomes. In general terms, CGA scores for patients with mPCa were lower than those for patients without metastasis. Furthermore, functional QoL appeared to be worse for patients with metastasis, and global QoL (burden) was more strongly associated with frailty. CONCLUSION Frailty syndrome was related to a poorer QoL in patients with mPCa and its evaluation should be considered in clinical decision-making and when choosing the most appropriate active treatment, if any, to increase survival.
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8
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Management of metastatic disease and castration resistance. Prog Urol 2022; 32:1373-1419. [DOI: 10.1016/j.purol.2022.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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9
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Lai JI, Chao TC, Liu CY, Huang CC, Tseng LM. A systemic review of taxanes and their side effects in metastatic breast cancer. Front Oncol 2022; 12:940239. [PMID: 36303832 PMCID: PMC9592970 DOI: 10.3389/fonc.2022.940239] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/02/2022] [Indexed: 12/05/2022] Open
Abstract
Taxanes-containing chemotherapy constitutes an essential backbone for both early and metastatic breast cancer (mBC). However, the two major taxane drugs—paclitaxel and docetaxel—have distinct safety profiles. In this review, we summarize the safety outcome and management following treatment with both taxanes from selected clinical trials. We utilized PubMed to perform literature search before April 2021. Five phase III randomized controlled trials with reports of individual taxane adverse events (AEs) were included in this review. Grade 3/4 AEs were summarized and discussed extensively. The rates of grade 3/4 neutropenia were higher with docetaxel than with paclitaxel. For non-hematologic grade 3/4 AEs, peripheral neuropathy was more frequent with paclitaxel while fluid retention was more frequent with docetaxel. Compared to paclitaxel, docetaxel had a higher rate of grade 3/4 gastrointestinal AEs. Grade 3/4 myalgia were generally comparable between the two taxanes. Except for neutropenia, the incidence rate of grade 3/4 AEs of taxanes was generally manageable. Peripheral neuropathy was more common with paclitaxel while grade 3/4 neutropenia was more common with docetaxel.
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Affiliation(s)
- Jiun-I. Lai
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chung Chao
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- *Correspondence: Ling-Ming Tseng, ;
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10
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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.
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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.
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11
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Alcaraz Asensio A, Alvarez Ossorio JL, Cozar Olmo JM, Chantada Abal V, Juarez Soto A, Linares Espinos E, Moreno Jimenez J, Muñoz Rodriguez J, Perez Fentes D, Plata Bello A, Rodrigo Aliaga M, Unda Urzaiz M, Vilaseca A. Non-metastatic castration-resistant prostate cancer: management recommendations. Actas Urol Esp 2022; 46:193-213. [PMID: 35305957 DOI: 10.1016/j.acuroe.2021.11.001] [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: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.
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Affiliation(s)
- A Alcaraz Asensio
- Servicio de Urología, Hospital Clinic de Barcelona, Barcelona, Spain.
| | | | - J M Cozar Olmo
- Servicio de Urología, Hospital Virgen de Las Nieves, Granada, Spain
| | - V Chantada Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A Juarez Soto
- Servicio de Urología, Hospital de Jerez, Jerez de la Frontera, Jerez, Spain
| | | | - J Moreno Jimenez
- Servicio de Urología, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Muñoz Rodriguez
- Servicio de Urología, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - D Perez Fentes
- Servicio de Urología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - A Plata Bello
- Servicio de Urología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - M Rodrigo Aliaga
- Servicio de Urología, Hospital General Universitario Castellón, Castellón, Spain
| | - M Unda Urzaiz
- Servicio de Urología, Hospital Universitario de Basurto, Bilbao, Spain
| | - A Vilaseca
- Servicio de Urología, Hospital Clinic de Barcelona, Barcelona, Spain
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12
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Outcome of primary androgen deprivation therapy in super-elderly men with localized high-risk prostate cancer. Anticancer Drugs 2022; 33:534-538. [PMID: 35276692 DOI: 10.1097/cad.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to provide certain data on clinical outcome of primary androgen deprivation therapy in men over 80 years of age with localized high-risk prostate cancer. This study included 54 Japanese super-elderly men with high-risk prostate cancer treated with primary androgen deprivation therapy between 2005 and 2015. The median overall survival was 9.1 years (95% confidence interval, 8.1-10.1) and no patient died from prostate cancer. Overall, 51.9% of patients experienced any grade of adverse events following androgen deprivation therapy. Associations between clinicopathological factors including comorbidity count at initial diagnosis and overall survival were investigated. On multivariate analysis, only comorbidity count at initial diagnosis [≥2 vs. ≤1; hazard ratio, 5.34 (95% confidence interval, 1.55-18.49); P = 0.003] was an independent risk factor for overall survival. Our findings suggest that comorbidity count at initial diagnosis is robustly prognostic for overall survival. For super-elderly men with localized high-risk prostate cancer, comorbidity count at initial diagnosis should be emphasized when deciding whether primary androgen deprivation therapy is necessary or not.
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13
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Ramírez-Martín R, Pérez-Rodríguez P, Menéndez-Colino R, Martín Maestre I, Gazo Martínez JA, Marijuán Martín JL, Alarcón Alarcón T, Díez Sebastián J, González-Montalvo JI. Prehabilitation and perioperative geriatric care in patients aged over 80 years with colorectal cancer: Results of a cross-speciality geriatrics program. J Geriatr Oncol 2022; 13:813-820. [DOI: 10.1016/j.jgo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
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14
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Narita S, Hatakeyama S, Sakamoto S, Kato T, Inokuchi J, Matsui Y, Kitamura H, Nishiyama H, Habuchi T. Management of prostate cancer in older patients. Jpn J Clin Oncol 2022; 52:513-525. [PMID: 35217872 DOI: 10.1093/jjco/hyac016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/31/2022] [Indexed: 01/22/2023] Open
Abstract
The incidence of prostate cancer among older men has increased in many countries, including Asian countries. However, older patients are ineligible for inclusion in large randomized trials, and the existing guidelines for the management of patients with prostate cancer do not provide specific treatment recommendations for older men. Therefore, generation of evidence for older patients with prostate cancer is a key imperative. The International Society of Geriatric Oncology has produced and updated several guidelines for management of prostate cancer in older men since 2010. Regarding localized prostate cancer, both surgery and radiotherapy are considered as feasible treatment options for intermediate- and high-risk prostate cancer even in older men, whereas watchful waiting and active surveillance are useful options for a proportion of these patients. With regard to advanced disease, androgen-receptor axis targets and taxane chemotherapy are standard treatment modalities, although dose modification and prevention of adverse events need to be considered. Management strategy for older patients with prostate cancer should take cognizance of not only the chronological age but also psychological and physical condition, socio-economic status and patient preferences. Geriatric assessment and patient-reported health-related quality of life are important tools for assessing health status of older patients with prostate cancer; however, there is a paucity of evidence of the impact of these tools on the clinical outcomes. Personalized management according to the patient's health status and tumour characteristics as well as socio-economic condition may be necessary for treatment of older patients with prostate cancer.
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Affiliation(s)
- Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuma Kato
- Department of Urology, Kagawa University School of Medicine, Kagawa, Japan
| | - Juichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Kitamura
- Department of Urology, University of Toyama Faculty of Medicine, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Tsukuba University School of Medicine, Tsukuba, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
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15
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Martinez-Recio S, Perez-Wert JP, Martinez-Fdez S, Jimenez-Bou D, Ruiz-Gutierrez I, Peña J, Pertejo A, Espinosa E, Pinto A. COMPARISON OF 2-WEEKLY AND 3-WEEKLY DOSING OF DOCETAXEL IN METASTATIC PROSTATE CANCER. Clin Genitourin Cancer 2022; 20:363-370. [DOI: 10.1016/j.clgc.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 12/20/2022]
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16
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Alcaraz Asensio A, Alvarez Ossorio J, Cozar Olmo J, Chantada Abal V, Juarez Soto A, Linares Espinos E, Moreno Jimenez J, Muñoz Rodriguez J, Perez Fentes D, Plata Bello A, Rodrigo Aliaga M, Unda Urzaiz M, Vilaseca A. Cáncer de próstata resistente a la castración no metastásico: recomendaciones de manejo. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Matsugasumi T, Okihara K, Tsujimoto M, Sato O, Imura T, Yamada Y, Fujihara A, Shiraishi T, Hongo F, Ukimura O. Impact of prostate-specific antigen screening on tumor size in patients with prostate cancer in a super-aging district in Kyoto, Japan. Int J Clin Oncol 2021; 26:2303-2309. [PMID: 34537890 DOI: 10.1007/s10147-021-02016-5] [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: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Population-based prostate-specific antigen (PSA) screening is effective for reducing prostate cancer (PCa)-related mortality rates. In this study, we assessed biopsy-proven maximum cancer core length (MCCL) and maximum cancer diameter on magnetic resonance imaging (MRI; MCDM) in prostate biopsy and multiparametric MRI (mp-MRI) by PCa detection. METHODS We retrospectively assessed 214 male PCa patients and 187 PCa patients with Prostate Imaging Reporting and Data System version 2 (PI-RADS) category 3-5 lesions in pre-biopsy mp-MRI and targeted biopsy characteristics. The mean biopsy-proven MCCL and MCDM were compared among three PSA screening groups, namely the population-based PSA screening (PBS), opportunistic PSA screening (OPS), and symptomatic outpatient PSA examination (SOP) groups. RESULTS The median age and PSA value of the 214 participants were 75 years and 7.9 ng/mL, respectively. In the PBS, OPS, and SOP groups, the median ages were 73, 76, and 76 years, respectively (p = 0.046); PSA values were 7.2, 9.5, and 11.5 ng/mL, respectively (p < 0.001); and biopsy-proven MCCL and MCDM were significantly increased to 7, 10, and 14 mm (p < 0.001) and to 11, 15, and 17 mm (p < 0.001), respectively. In the 187 PCa patients with PI-RADS category 3-5 lesions on mp-MRI, MCDM were 11, 14, and 17 mm (p < 0.001), respectively. CONCLUSIONS The biopsy-proven MCCL and MCDM were significantly smaller in the PBS and OPS groups than in the SOP group, which suggests that PSA screening detected PCa earlier than in symptomatic patients. PSA screening with MRI could objectively lead to earlier diagnosis based on tumor size.
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Affiliation(s)
- Toru Matsugasumi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Masashi Tsujimoto
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Osamu Sato
- Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Tetsuya Imura
- Department of Pathology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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18
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González Serrano A, Martínez Tapia C, de la Taille A, Mongiat-Artus P, Irani J, Bex A, Paillaud E, Audureau E, Barnay T, Laurent M, Canouï-Poitrine F. Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study. Cancers (Basel) 2021; 13:4694. [PMID: 34572921 PMCID: PMC8468518 DOI: 10.3390/cancers13184694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023] Open
Abstract
The guidelines on prostate cancer treatment in older men recommend evaluating the patient's underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline-discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41-51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17-0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): -3.1 months (-5.3, -1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: -3.3 months (-6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.
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Affiliation(s)
- Adolfo González Serrano
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Claudia Martínez Tapia
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
| | - Alexandre de la Taille
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Urology, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Pierre Mongiat-Artus
- Université de Paris, INSERM UMR_S1165, F-75010 Paris, France;
- Department of Urology, AP-HP, Hôpital Saint Louis, F-75010 Paris, France
| | - Jacques Irani
- Faculty of Medicine, Université Paris Saclay, F-94270 Le Kremlin-Bicêtre, France;
- Department of Urology, AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London NW3 2QG, UK;
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Geriatrics, Paris Cancer Institute CARPEM, AP-HP, Hôpital Européen Georges Pompidou, F-75006 Paris, France
- Faculty of Health, Univeristé de Paris, F-75006 Paris, France
| | - Etienne Audureau
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Thomas Barnay
- ERUDITE Research Unit, Univ Paris Est Creteil, F-94010 Créteil, France;
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Internal Medicine and Geriatrics, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (C.M.T.); (A.d.l.T.); (E.P.); (E.A.); (M.L.); (F.C.-P.)
- Department of Public Health, AP-HP, Hôpital Henri Mondor, F-94010 Creteil, France
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19
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Scailteux LM, Capelle V, Balusson F, Oger E, Vincendeau S, Mathieu R, Chapron A. Changes in prostate cancer screening practice by blood PSA testing between 2011 and 2017, a French population-based study. Curr Med Res Opin 2021; 37:1435-1441. [PMID: 34134580 DOI: 10.1080/03007995.2021.1944075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study was to determine the trend of first blood prostate-specific antigen (PSA) test prescription in France between 2011 and 2017, based on the assumption that prostate cancer (PCa) screening is expected to decline over the years. METHOD Using a representative sample of the French population from the French Health Insurance database, we identified 50-52-year-old men without PCa and without any blood PSA test in the five years before 2011, 2014 and 2017 (January 1-December 31 of each year). For each of these three years, the primary outcome was the first reimbursement of a blood PSA test. We used a logistic regression model with first blood PSA test as the outcome and year as the main explanatory variable. As secondary objectives, we also identified the prescriber's specialty, the urological consultation frequency, and the number of prostate biopsies in the year after the first blood PSA test reimbursement (only for 2011 and 2014). RESULTS In 2011, 2014 and 2017, 5 275, 5 792 and 5 887 50-52-year-old men, respectively, were included. The percentage of patients with a first blood PSA test prescription decreased linearly from 2011 to 2017: 15.7% in 2011, 13.2% in 2014, and 12.4% in 2017 (p < .001). Blood PSA testing was mainly prescribed by general practitioners (>95%). The median interval between PSA tests was 13 months in 2011 and 14 months in 2014. Fewer than 10% of men had ≥1 consultation with an urologist during the year after the first blood PSA test. After the first blood PSA test, eight prostate biopsies were performed in 2011 and two in 2014. CONCLUSION Our results suggest that in France, PCa screening is a primary care issue. Although PCa screening remains controversial and confusion exists about the best practice, our study showed a linear decrease of blood PSA test prescriptions for 50-52-year-old men between 2011 and 2017, although the reason for screening was unknown. As clinical information was not available, additional evidence is needed to determine the real impact of this decrease on the cancer-specific and overall mortality.
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Affiliation(s)
- Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, REPERES [Pharmacoepidemiology and Heath Services Research], Rennes, France
| | | | - Frédéric Balusson
- Univ Rennes, CHU Rennes, REPERES [Pharmacoepidemiology and Heath Services Research], Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, REPERES [Pharmacoepidemiology and Heath Services Research], Rennes, France
| | | | - Romain Mathieu
- Urology Department, Rennes University Hospital, Rennes
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Anthony Chapron
- Département de Médecine Générale, Univ Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
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20
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Wujanto C, Tey J, Vellayappan B, So J, Yong WP, Shabbir A, Tseng M, Soon YY, Ho F. Outcomes of oesophageal cancer treated with neoadjuvant compared with
definitive chemoradiotherapy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: We report outcomes of patients with oesophageal cancer treated with neoadjuvant
chemoradiotherapy (NACRT) plus surgery or definitive chemoradiotherapy (chemoRT) at our institution.
Methods: We retrospectively reviewed patients who underwent chemoRT from 2005 to 2017. The
primary outcome was overall survival (OS). Secondary outcomes were disease-free survival (DFS)
and toxicities.
Results: We identified 96 patients with median age of 64 years and squamous cell carcinoma in
82.3%. Twenty-nine patients (30.2%) received NACRT plus surgery, 67 patients (69.8%) received
definitive chemoRT. Median follow-up was 13.5 months. The 3/5-year OS were 26.4%/13.4%,
and 59.6%/51.6% in the definitive chemoRT and NACRT plus surgery groups, respectively. The
3/5-year DFS were 19.3%/12.3%, and 55.7%/37.2% in the definitive chemoRT and NACRT plus
surgery groups, respectively. NACRT plus surgery significantly improved OS (hazard ratio [HR]
0.40, 95% confidence interval [CI] 0.22–0.72, P<0.01) and DFS (subhazard ratio [SHR] 5.21, 95
CI 1.20–22.7, P=0.03). Multivariable analysis for OS in the definitive chemoRT group indicated
stage (1–2 vs 3–4a; HR 2.17, 95% CI 1.15–4.11, P=0.02) and feeding tube (no tube versus tube; HR
1.85, 95% CI 1.00–3.43, P=0.05) as significantly associated with OS. The cumulative incidence of local
recurrence was significantly higher in the definitive chemoRT group (SHR 5.21, 95 CI 1.2022.7,
P=0.03). Nineteen patients (65.5%) had postoperative complications.
Conclusion: NACRT plus surgery improved OS and DFS. However, in view of treatment-related
complications, careful selection of patients is warranted. With the predominant histology of our cohort
being squamous cell carcinoma (SCC), our results may be more re levant for those with SCC.
Keywords: Neoadjuvant chemoradiotherapy, oesophageal cancer, surgery
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Affiliation(s)
| | - Jeremy Tey
- National University Cancer Institute, Singapore
| | | | - Jimmy So
- National University Cancer Institute, Singapore
| | | | | | | | | | - Francis Ho
- National University Cancer Institute, Singapore
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21
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Comparison of G8 and ISAR Screening Results in Geriatric Urology. MEDICINES 2021; 8:medicines8080040. [PMID: 34436219 PMCID: PMC8398154 DOI: 10.3390/medicines8080040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Background: The G8 and ISAR scores are two different screening tools for geriatric risk factors and frailty. The aim of this study was to compare the G8 and ISAR screening results in a cohort of urogeriatric patients to help clinicians to better understand and choose between the two tests. Methods: We retrospectively evaluated 100 patients at the age of 75 and above who were treated for different urological conditions. All routinely and prospectively underwent G8 and ISAR screening tests. A G8 score ≤ 14 and an ISAR score > 2 were considered positive. The results for the two tests were compared and correlated to clinical data. Results: The mean age of the patients was 83 y (min. 75–max. 101); 78 of the patients were male, while 22 were female; 58 of the patients were G8-positive, while 42 were G8-negative; and 24 were ISAR-positive, while 76 ISAR were negative. All the ISAR-positive patients were also G8-positive. There was a significant negative correlation between the G8 and ISAR scores (r = −0.77, p < 0.001). Both tests correlated significantly with the Charlson comorbidity index, length of stay, number of coded diagnosis, and Braden score (p < 0.05). Conclusion: Both tests are significantly correlated with each other and to clinical data related to geriatric frailty. However, the G8 score has a much higher rate of positive tests, which limits its use in daily routine, and the ISAR score is therefore preferable. For “fit” geriatric patients, however, a negative G8 score can be of great use as a confirmatory test for further decision making.
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22
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Kreis K, Horenkamp-Sonntag D, Schneider U, Zeidler J, Glaeske G, Weissbach L. Safety and survival of docetaxel and cabazitaxel in metastatic castration-resistant prostate cancer. BJU Int 2021; 129:470-479. [PMID: 34242474 DOI: 10.1111/bju.15542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate real-world haematological toxicity, overall survival (OS) and the treatment characteristics of docetaxel and cabazitaxel chemotherapy in metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS This retrospective claims data study followed patients with mCRPC receiving cabazitaxel or docetaxel from their first chemotherapy infusion. Haematological toxicities were measured using treatment codes and inpatient diagnoses. OS was estimated using the Kaplan-Meier method. A multivariable Cox regression analysis was used to identify OS predictors. RESULTS Data from 539 patients administered docetaxel and 240 administered cabazitaxel were analysed. Regarding adverse events, within 8 months of treatment initiation, some kind of treatment for haematological toxicity was documented in 31% of patients given docetaxel and in 61% of patients given cabazitaxel. In the same period, hospitalization associated with haematological toxicity was documented in 11% of the patients in the docetaxel cohort and in 15% of the patients in the cabazitaxel cohort. In the docetaxel cohort, 9.9% of patients required reverse isolation and 13% were diagnosed with sepsis during hospitalization. In the cabazitaxel cohort, the cumulative incidence was 7.9% and 15%, respectively. The median OS was reached at 21.9 months in the docetaxel cohort and, because of a later line of therapy, at 11.3 months in the cabazitaxel cohort. A multivariate Cox regression revealed that indicators of locally advanced and metastatic disease, severe comorbidities, and prior hormonal/cytotoxic therapies were independent predictors of early death. CONCLUSION Cabazitaxel patients face an increased risk of haematological toxicities during treatment. Together with their short survival time, this calls for a strict indication when using cabazitaxel in patients with mCRPC.
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Affiliation(s)
- Kristine Kreis
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Germany
| | | | - Udo Schneider
- Techniker Krankenkasse, Versorgungsmanagement, Hamburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Germany
| | - Gerd Glaeske
- Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen - SOCIUM, Bremen, Germany
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23
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Faithfull S, Lemanska A, Poole K, Aning J, Manders R, Marshall J, Saxton J, Turner L, Griffin B. Obesity and low levels of physical activity impact on cardiopulmonary fitness in older men after treatment for prostate cancer. Eur J Cancer Care (Engl) 2021; 30:e13476. [PMID: 34143537 DOI: 10.1111/ecc.13476] [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: 11/18/2020] [Revised: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare fitness parameters and cardiovascular disease risk of older and younger men with prostate cancer (PCa) and explore how men's fitness scores compared to normative age values. 83 men were recruited post-treatment and undertook a cardiopulmonary exercise test (CPET), sit-to-stand, step-and-grip strength tests and provided blood samples for serum lipids and HbA1c. We calculated waist-to-hip ratio, cardiovascular risk (QRISK2), Charlson comorbidity index (CCI) and Godin leisure-time exercise questionnaire [GLTEQ]. Age-group comparisons were made using normative data. Men > 75 years, had lower cardiopulmonary fitness, as measured by VO2 Peak (ml/kg/min) 15.8 + 3.8 p < 0.001, and lower grip strength(28.6+5.2 kg p < 0.001) than younger men. BMI ≥30kg/m2 and higher blood pressure all contributed to a QRisk2 score indicative of 20% chance of cardiovascular risk within 10 years (mean: 36.9-6.1) p < 0.001. Age, BMI and perceived physical activity were significantly associated with lower cardiopulmonary fitness. Men with PCa > 75 years had more cardiovascular risk factors compared to normative standards for men of their age. Although ADT was more frequent in older men, this was not found to be associated with cardiopulmonary fitness, but obesity and low levels of physical activity were. Secondary prevention should be addressed in men with PCa to improve men's overall health.
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Affiliation(s)
- Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Jonathan Aning
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Ralph Manders
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - John Marshall
- PPI Representative, Prostate Cancer UK Charity, London, UK
| | - John Saxton
- Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Lauren Turner
- Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Bruce Griffin
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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24
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Does the type of cryoprobe affect oncological and functional outcomes in men with clinically localized prostate cancer treated with primary whole gland prostate cryoablation? Curr Urol 2021; 15:79-84. [PMID: 34168524 PMCID: PMC8221007 DOI: 10.1097/cu9.0000000000000015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background This study aimed to compare the oncological and functional outcomes of primary whole gland cryoablation of the prostate using the variable ice cryoprobe (V-Probe®) and the conventional fixed-size ice probe. Materials and methods We reviewed the Cryo On-Line Data Registry for men who were treated with primary whole gland prostate cryoablation from 2000 through 2017. A multivariate Cox proportional hazards model was used to compare timing to biochemical recurrence between the V-Probe® and fixed-size ice probe after adjusting for preoperative prostate-specific antigen (PSA), neoadjuvant androgen deprivation therapy, preoperative Gleason score, and preoperative T stage. Results A total of 1124 men were included. Median age, Gleason score, and pretreatment PSA were 70 years (interquartile range [IQR]: 65-74 years), 7 (IQR: 6-7) and 5.9 ng/mL (IQR: 4.6-8.1 ng/mL), respectively. The median follow-up time was 25.0 months (IQR: 11.2-48.6 months). V-Probes® were used in 269 (23.9%) cases and fixed-size ice probes in 858 (76.1%) cases. After adjusting for clinical T stage, PSA, neoadjuvant androgen deprivation therapy and preoperative Gleason score, on the multivariate Cox regression model, we found that there was no significant difference between the type of probe and timing to biochemical recurrence (p = 0.35). On multivariate logistic regression, using the V-Probe® was associated with a 91% increase in postoperative urinary retention compared to the fixed-size ice probe (p = 0.003). Conclusions The use of the V-Probe® versus conventional fixed-size ice probe was not associated with a difference in biochemical recurrence in patients undergoing primary cryoablation of the prostate.
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25
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Kim IH, Shin SJ, Kang BW, Kang J, Kim D, Kim M, Kim JY, Kim CK, Kim HJ, Maeng CH, Park K, Park I, Bae WK, Sohn BS, Lee MY, Lee JL, Lee J, Lim ST, Lim JH, Chang H, Jung JY, Choi YJ, Kim YS, Cho J, Joung JY, Park SH, Lee HJ. 2020 Korean guidelines for the management of metastatic prostate cancer. Korean J Intern Med 2021; 36:491-514. [PMID: 33561334 PMCID: PMC8137395 DOI: 10.3904/kjim.2020.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022] Open
Abstract
In 2017, Korean Society of Medical Oncology (KSMO) published the Korean management guideline of metastatic prostate cancer. This paper is the 2nd edition of the Korean management guideline of metastatic prostate cancer. We updated recent many changes of management in metastatic prostate cancer in this 2nd edition guideline. The present guideline consists of the three categories: management of metastatic hormone sensitive prostate cancer; management of metastatic castration resistant prostate cancer; and clinical consideration for treating patients with metastatic prostate cancer. In category 1 and 2, levels of evidence (LEs) have been mentioned according to the general principles of evidence-based medicine. And grades of recommendation (GR) was taken into account the quality of evidence, the balance between desirable and undesirable effects, the values and preferences, and the use of resources and GR were divided into strong recommendations (SR) and weak recommendations (WR). A total of 16 key questions are selected. And we proposed recommendations and described key evidence for each recommendation. The treatment landscape of metastatic prostate cancer is changing very rapid and many trials are ongoing. To verify the results of the future trials is necessary and should be applied to the treatment for metastatic prostate cancer patients in the clinical practice. Especially, many prostate cancer patients are old age, have multiple underlying medical comorbidities, clinicians should be aware of the significance of medical management as well as clinical efficacy of systemic treatment.
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Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Joon Shin
- Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Woog Kang
- Department of Oncology/Hematology, Kyungpook National University Hospital, Daegu, Korea
| | - Jihoon Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dalyong Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miso Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Young Kim
- Division of Hemato-Oncology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chan Kyu Kim
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hee-Jun Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Kwonoh Park
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Inkeun Park
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byeong Seok Sohn
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Min-Young Lee
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Lyun Lee
- Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junglim Lee
- Division of Medical Oncology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Seung Taek Lim
- Department of Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joo Han Lim
- Department of Hematology/Oncology, Inha University School of Medicine, Incheon, Korea
| | - Hyun Chang
- Division of Medical Oncology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Joo Young Jung
- Division of Hemato-Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yoon Ji Choi
- Division of Hematology-Oncology, Department of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Joung
- Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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26
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Fusco D, Ferrini A, Pasqualetti G, Giannotti C, Cesari M, Laudisio A, Ballestrero A, Scabini S, Odetti PR, Colloca GF, Monzani F, Nencioni A, Antonelli Incalzi R, Monacelli F. Comprehensive geriatric assessment in older adults with cancer: Recommendations by the Italian Society of Geriatrics and Gerontology (SIGG). Eur J Clin Invest 2021; 51:e13347. [PMID: 32648990 DOI: 10.1111/eci.13347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimizing the approach to older adults with cancer is now a priority given the increasing frequency of new cancer diagnoses that are made in the older population. The comprehensive geriatric assessment (CGA) represents the gold-standard for (1) defining prognosis and ability to withstand cancer treatments, (2) exploring the multiple aspects that define the complexity of frail older persons, and (3) designing person-tailored interventions. MATERIALS AND METHODS In this document, based on a comprehensive revision of the literature, the Italian Society for Geriatrics and Gerontology proposes a CGA model (ONCOGER CGA) to be adopted by oncology centers for their routine approach to older patients with cancer. RESULTS AND DISCUSSION A widespread use of this standardized CGA format will facilitate comparisons across institutions, promote studies based on a multidimensional patient assessment, and foster the inclusion of geriatric endpoints in oncological clinical trials. Furthermore, we predict that the use of a standardized CGA approach will increase the integration of geriatricians into oncology care teams with the final result of improving therapeutic choices and clinical outcomes.
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Affiliation(s)
- Domenico Fusco
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | | | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Laudisio
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Patrizio R Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe F Colloca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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27
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Iwamoto H, Izumi K, Kadomoto S, Makino T, Naito R, Yaegashi H, Shigehara K, Kadono Y, Mizokami A. A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age. Asian J Androl 2021; 23:36-40. [PMID: 32769233 PMCID: PMC7831834 DOI: 10.4103/aja.aja_39_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A standard modality for prostate cancer detection in men 75 years and older has not been established. A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer. A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital (Kanazawa, Japan) between 2000 and 2017. Of the 2251 patients who underwent prostate biopsy, 254 had clinically significant prostate cancer (CSPC) with a Gleason score (GS) of≥7 and 273 had a GS of <7 or no malignancy. In this study, patients aged 75 years or older were classified as elderly patients. GS ≥ 7 was characterized by a prostate-specific antigen (PSA) of the maximum area under the curve of 12 ng ml-1 with a sensitivity of 76.2% and a specificity of 73.2%. For PSA levels between 4 ng ml-1 and 12 ng ml-1, based on the maximum area under the curve, patients with three or four of the following factors may present a GS of ≥ 7: percent free PSA >24, PSA density≥ 0.24 ng ml-2, positive findings on digital rectal examination, and transrectal with 90.0% sensitivity and 67.4% specificity. In this study, we found that raising the PSA cutoff to 12 ng ml-1 for CSPC in elderly individuals can significantly reduce unnecessary prostate biopsies. Furthermore, CSPC could be efficiently discovered by combining the four supplementary markers in patients with a PSA level of 4-12 ng ml-1. By performing this screening for elderly men over 75 years of age, unnecessary biopsies may be reduced and CSPC may be detected efficiently.
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Affiliation(s)
- Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
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28
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Couderc AL, Nicolas E, Boissier R, Boucekine M, Bastide C, Badinand D, Rossi D, Mugnier B, Villani P, Karsenty G, Cowen D, Lechevallier E, Muracciole X. Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D'Amico Intermediate-/High-Risk Prostate Cancer in Older Patients. Cancers (Basel) 2020; 13:E75. [PMID: 33383957 PMCID: PMC7795189 DOI: 10.3390/cancers13010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE/OBJECTIVE The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. MATERIAL AND METHODS From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. RESULTS Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. CONCLUSION Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
| | - Emanuel Nicolas
- Department of Medical Oncology, University Hospital of Nimes, 30000 Nimes, France;
- IDESP Institute Desbrest of Epidemiology and Public Health, Research Unit INSERM, University of Montpellier, 34000 Montpellier, France
| | - Romain Boissier
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Mohammed Boucekine
- Department of Public Health, EA 3279 Self-Perceveid Health Assessment Research Unit, Medical School, Aix-Marseille University, 13005 Marseille, France;
| | - Cyrille Bastide
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Nord Hospital, AP-HM, 13015 Marseille, France
| | - Delphine Badinand
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
| | - Dominique Rossi
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Nord Hospital, AP-HM, 13015 Marseille, France
| | - Benedicte Mugnier
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
| | - Patrick Villani
- Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France; (B.M.); (P.V.)
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
| | - Gilles Karsenty
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Didier Cowen
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
| | - Eric Lechevallier
- Medical School, Aix-Marseille University, 13005 Marseille, France; (R.B.); (C.B.); (D.R.); (G.K.); (D.C.); (E.L.)
- Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
| | - Xavier Muracciole
- Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France; (D.B.); (X.M.)
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Bessems SAM, Konsten JLM, Vogelaar JFJ, Csepán-Magyar R, Maas HAAM, van de Wouw YAJ, Janssen-Heijnen MLG. Frailty screening by Geriatric-8 and 4-meter gait speed test is feasible and predicts postoperative complications in elderly colorectal cancer patients. J Geriatr Oncol 2020; 12:592-598. [PMID: 33158771 DOI: 10.1016/j.jgo.2020.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. METHODS This retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. RESULTS 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. CONCLUSION Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications.
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Affiliation(s)
- Stan A M Bessems
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
| | - Joop L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Reka Csepán-Magyar
- Department of Geriatric Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Yes A J van de Wouw
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Pinto A, Gironés R, Custodio AB, Muñoz MDM, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Undertreatment and overtreatment in older patients treated with chemotherapy. J Geriatr Oncol 2020; 12:381-387. [PMID: 33109485 DOI: 10.1016/j.jgo.2020.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses. PATIENTS AND METHODS Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression. RESULTS Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05). CONCLUSIONS The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.
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Affiliation(s)
- Jaime Feliu
- Oncology department, Hospital Universitario La Paz, Madrid, Spain; Cátedra UAM-AMGEN, CIBERONC, Spain.
| | - Enrique Espinosa
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Irene Paredero
- Oncology department, Hospital Universitario Dr. Peset. Valencia, Spain
| | - Elisenda Llabrés
- Oncology department, Hospital Universitario Insular de Gran Canarias, Spain
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL, Hospitalet, Barcelona, Spain
| | - Beatriz Losada
- Oncology department, Hospital Universitario de Fuenlabrada, Spain
| | - Alvaro Pinto
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | - Regina Gironés
- Oncology department, Hospital Universitari y Politécnic La Fé, Valencia, Spain
| | | | | | | | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL, Hospitalet, Barcelona, Spain
| | - Patricia Cruz
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
| | - Oliver Higuera
- Oncology department, Hospital Universitario La Paz, Madrid, Spain
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Liuu E, Saulnier PJ, Gand E, Ragot S, Valero S, Jamet A, Hadjadj S, Paccalin M. Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res 2020; 32:1809-1819. [PMID: 31898171 DOI: 10.1007/s40520-019-01362-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Frailty, diabetes and cancer are associated with aging, but the relationship between these conditions is not well defined. AIMS We studied older patients with cancer from the prospective single-center cohort ANCRAGE (ANalyses of CanceR in AGEd) aiming to determine the impact of type 2 diabetes (T2D) and its vascular complications (VC) on frailty and adverse outcomes (mortality, unplanned readmission) during follow-up. METHODS Analysis of cohort patients ≥ 75 years, included between 2009 and 2017, who underwent a comprehensive geriatric assessment (CGA). Variables of interest were history of T2D and VC, tumor site and metastatic status, CGA including eight domains (social environment, functional status, mobility, nutrition, mood, cognition, polypharmacy and comorbidities) and frailty. RESULTS Among 1092 patients (47% female, mean age 82 ± 5 years), 219 (20%) had a reported diagnosis of T2D at baseline including 152 (69%) with VC. The most common tumor sites were prostate (15%), breast (15%), skin (12%), and colorectum (11%); 29% of patients had a metastatic disease. Frailty was highly prevalent (84%). During follow-up (median of 15.3 months), 653 (60%) patients died (60% no T2D, 43% T2D without VC, 66% with VC). After adjustment for age, gender and metastatic status, diabetics with VC had a higher risk of all-cause death (aHR1.89, 1.24-2.86, p = 0.004). Death was more frequently due to a non-cancer cause (p < 0.001). No difference in unplanned readmissions was observed in the three groups. Frailty was an independent risk factor for mortality and unplanned readmissions (p < 0.001 both). CONCLUSION In older cancer patients from the prospective ANCRAGE cohort, all-cause mortality was significantly higher in frail patients and those with complicated T2D, a finding questioning the quality of care management in such vulnerable patients, and stimulating further research in this multidisciplinary field.
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Mathaiyan DK, Tripathi SP, Raj JP, Sivaramakrishna B. Histopathology, pharmacotherapy, and predictors of prostatic malignancy in elderly male patients with raised prostate-specific antigen levels - A prospective study. Urol Ann 2020; 12:132-137. [PMID: 32565650 PMCID: PMC7292440 DOI: 10.4103/ua.ua_68_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/20/2019] [Indexed: 11/04/2022] Open
Abstract
Background Prostate cancer is the second most common cancer among adult men in the world, and the diagnosis requires biopsy. Prostate-specific antigen (PSA) test along with digital rectal examination (DRE) increases the detection rate of prostate cancer than DRE alone. The objective of this study was to correlate serum PSA level with histopathological diagnosis, identify the predictors of malignancy, and describe the pharmacotherapy of patients with serum PSA levels >4 ng/ml. Materials and Methods This was a hospital-based observational study done among patients who presented with lower urinary tract symptoms and PSA levels >4 ng/ml who were planned to undergo prostatic biopsy. DRE followed by transrectal ultrasound (TRUS) assessment and guided sextant (6-core) prostatic biopsy was performed. Results One hundred and four patients were screened and 87 were included. Nineteen patients were diagnosed with malignancy, and among them, eight had bone metastasis. Spearman's correlation coefficient between PSA and malignancy was 0.449 (P ≤ 0.001). Multivariate analysis suggested that the factors (adjusted odds ratio; 95% confidence interval; P value) such as increasing age (1.127; 1.013, 1.253; 0.027), nodular prostate (22.668; 4.655, 110.377; P < 0.001), and PSA (1.034; 1.004, 1.064; 0.024) were significant predictors of prostate cancer. All patients with benign prostatic hyperplasia were advised a combination therapy with 5-alpha reductase inhibitor and selective alpha-1 receptor antagonist while those with malignancy were prescribed androgen deprivation therapy with antiosteoporosis therapy. Conclusion In elderly patients with raised PSA levels or suspicious DRE findings, TRUS-guided prostate is recommended to rule out malignancy and plan appropriate management.
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Affiliation(s)
- Dhinesh Kumar Mathaiyan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Jeffrey Pradeep Raj
- Department of Clinical Pharmacology, Seth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India
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Bagayogo F, Le Berre M, Ruchon C, Denis JL, Lamothe L, Vedel I, Lapointe L. Caring for older cancer patients: A scoping review. Health Policy 2020; 124:1008-1016. [PMID: 32532568 DOI: 10.1016/j.healthpol.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/08/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population. To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results. From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers. This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme.
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Affiliation(s)
- Fatou Bagayogo
- York University School of Health Policy and Management, Canada.
| | - Mélanie Le Berre
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Christian Ruchon
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Jean-Louis Denis
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada; Research Center of the CHUM (CRCHUM), 900 Saint-Denis street, H2X 0A9, Montreal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada
| | - Isabelle Vedel
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada; Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Liette Lapointe
- Desautels Faculty of Management, McGill University, 1001 Sherbrooke Street West, Montreal, Quebec, H3A 1G5, Canada
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Shevach JW, Weiner AB, Kasimer RN, Miller CH, Morgans AK. Risk Assessment and Considerations for Proper Management of Elderly Men with Advanced Prostate Cancer: A Systematic Review. Eur Urol Oncol 2020; 3:400-409. [PMID: 32471792 DOI: 10.1016/j.euo.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Treatment decisions for elderly men with prostate cancer are complicated by the intersection of competing risks of cancer, potential complications of treatment, and individual patients' comorbidities. OBJECTIVE To perform a systematic review of data guiding the assessment of elderly prostate cancer patients that addresses the risk from cancer and treatment, and to discuss a patient-centered approach to incorporating these factors into decision making. EVIDENCE ACQUISITION Evidence was gathered via a systematic review of the current literature. The search strategy used the terms prostate cancer, elderly, geriatric, >75 yr of age, risk assessment, and treatment in several combinations, and was limited to phase ≥ II clinical trials published between January 2008 and November 2018. Additional supporting literature for the discussion was pulled by hand search. EVIDENCE SYNTHESIS The benefits of treatment identified for systemic therapies commonly used to treat men with prostate in general extend to elderly patients. Evidence supports a multifaceted assessment of the risks of cancer and aging, and an understanding of the side effects of treatment to optimally guide therapeutic decision making for elderly patients. There is little evidence defining a geriatric risk stratification system specific to prostate cancer, and recommendations are predominantly based on adapted geriatric oncology approaches and expert consensus. CONCLUSIONS The care of elderly men with prostate cancer should incorporate a review of cancer risk, an assessment of aging, and an understanding of the effects of treatment to provide the patient with thorough and personalized guidance for treatment decisions. Future studies of elderly men with prostate cancer can define and validate ideal risk stratification methods as well as management approaches that may be distinct from those for younger populations. PATIENT SUMMARY Treatment decisions for elderly men with prostate cancer require consideration of the risk posed by the cancer coupled with an understanding of the patient's general health status.
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Bluethmann SM, Wang M, Wasserman E, Chen C, Zaorsky NG, Hohl RJ, McDonald AC. Prostate cancer in Pennsylvania: The role of older age at diagnosis, aggressiveness, and environmental risk factors on treatment and mortality using data from the Pennsylvania Cancer Registry. Cancer Med 2020; 9:3623-3633. [PMID: 32212232 PMCID: PMC7221418 DOI: 10.1002/cam4.3003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background To assess: (a) cancer treatment in prostate cancer survivors (PCS) by age at diagnosis (ADx) and prostate cancer (PC) aggressiveness; (b) potential impact on PC mortality; and (c) these results in the context of environmental/behavioral risk factors on PCS in Pennsylvania. Methods Prostate cancer survivors ages ≥40 years were identified from the 2004‐2014 Pennsylvania Cancer Registry (PCR). Demographic/clinical descriptors and PC treatment were extracted from PCR. Prostate cancer aggressiveness was defined by clinical/pathologic Gleason score and tumor stage. Logistic and Cox regression analyses tested associations between treatment received and PC‐specific mortality. County‐level data from the Pennsylvania BRFSS were used to estimate cancer‐related behavioral risk factors (eg, smoking, physical inactivity, fruit/vegetable consumption [FV], alcohol use) and used as covariates. Results There were 90 694 PCS ages 40‐105 years (mean age = 66.19 years, SD = 9.25) included. Most were non‐Hispanic white men (83%). Prostate cancer survivors ≥75 years were least likely to receive any treatment but men ages 65‐74 were more likely to receive combined therapies (OR = 1.47; 95% CI 1.28, 1.69) vs PCS ages 40‐54 years, controlling for covariates. Prostate cancer survivors 55‐75+ with aggressive PC who received any treatment vs no definitive treatment had significantly reduced mortality. Men from counties with high obesity and smoking rates were significantly less likely to receive any treatment than men living in counties with lower rates of these risk factors. Prostate cancer survivors who lived in counties with high rates of physical inactivity and had high rates of sufficient FV consumption were slightly more likely to receive cancer treatment vs no definitive treatment compared to men who lived in counties with high rates of physical activity and lower FV consumption. Conclusions We observed a general age‐related decline in receipt of treatment. Prostate cancer survivors ages ≥75 years were significantly less likely to get any cancer treatment compared to younger PCS. However, most men with more aggressive disease who received any treatment had greatly reduced PC mortality, regardless of age. Considering environmental/behavioral risk factors may attenuate PC risk and inform treatment options.
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Affiliation(s)
- Shirley M Bluethmann
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Ming Wang
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Emily Wasserman
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nicholas G Zaorsky
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Raymond J Hohl
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Alicia C McDonald
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
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Matsubara N, Suzuki K, Kazama H, Tsukube S, Seto T, Matsuyama H. Cabazitaxel in patients aged ≥80 years with castration-resistant prostate cancer: Results of a post-marketing surveillance study in Japan. J Geriatr Oncol 2020; 11:1067-1073. [PMID: 32198082 DOI: 10.1016/j.jgo.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/23/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Data on the safety and efficacy of cabazitaxel in patients aged ≥80 years with castration-resistant prostate cancer (CRPC) are limited. We report the safety (adverse drug reactions [ADRs]) and efficacy (overall survival [OS], time to treatment failure [TTF], and prostate-specific antigen [PSA] response rates) in patients aged <80 or ≥80 years treated with cabazitaxel for CRPC in clinical practice. MATERIALS AND METHODS We performed post-hoc subgroup analyses of a Japanese post-marketing surveillance study involving 662 patients with CRPC treated with cabazitaxel between September 2014 and June 2016. RESULTS In patients aged <80 (n = 610) and ≥80 years (n = 49), median PSA at baseline was 168.7 and 109.0 ng/mL, and 86.7% and 83.7% of patients were previously treated with enzalutamide and/or abiraterone. ADRs (all grade) occurred in 77.2% and 79.6% of patients aged <80 and ≥80 years, with grade three/worse ADRs in 61.8% and 63.3% of patients. Hematologic toxicities were the most common grade three/worse ADRs, including neutropenia, febrile neutropenia, and anemia in both subgroups. No specific ADRs were observed in patients aged ≥80 years. The PSA response and median OS and TTF were 28.3%, 292 days, and 116 days in patients aged ≥80 years, and 29.7%, 319 days, and 125 days in patients aged <80 years. CONCLUSION Cabazitaxel could be a treatment option for CRPC in patients aged ≥80 years based on its safety and efficacy profiles. This is the first report to investigate the safety and efficacy of cabazitaxel in patients aged ≥80 years with CRPC.
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Affiliation(s)
- Nobuaki Matsubara
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.
| | - Kazuhiro Suzuki
- Department of Urology, Graduate School of Medicine, Gunma University, Gunma, Japan
| | | | | | | | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Clinical-genomic Characterization Unveils More Aggressive Disease Features in Elderly Prostate Cancer Patients with Low-grade Disease. Eur Urol Focus 2020; 7:797-806. [PMID: 32156491 DOI: 10.1016/j.euf.2020.02.008] [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: 12/15/2019] [Revised: 01/19/2020] [Accepted: 02/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Over 20% of men diagnosed with prostate cancer (PC) are ≥75 yr old. More objective disease-specific indices for predicting outcomes beyond chronological age are necessary. OBJECTIVE To analyze age-related differences in clinical-genomic prognostic features of aggressiveness in localized PC. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter cross-sectional study reported the use of the Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK) guidelines. Clinical-genomic data of patients who underwent a prostate biopsy or radical prostatectomy (RP) were obtained from the Decipher Genomic Resource Information Database (NCT02609269). INTERVENTION Our analyses focused on the 22-gene Decipher genomic classifier (GC) and 50-gene (PAM50) models in the biopsy and RP cohorts stratified by age. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the impact of age on GC scores and PAM50 molecular subtypes. Prognostic indices including Decipher GC scores, PAM50 molecular subtypes, National Comprehensive Cancer Network risk categories, and ISUP grade groups (IGGs) were stratified by age using multivariable logistic regression analyses. RESULTS AND LIMITATIONS Within histological low-risk IGGs, there were a higher proportion of patients with high-risk Decipher biopsy scores with age (age <60 yr: 10.1% IGG 1 and 29.9% IGG 2 vs age ≥80 yr: 22% IGG 1 and 37.7% IGG 2). The prevalence of the adverse phenotype luminal B (PAM50-defined) increased with age (age <60 yr: 22.7% and 40.2% vs age ≥80 yr: 29.7% and 49.1%, in patients with IGG 1 and IGG 2, respectively). In IGGs 3-5, no age differences were observed. Multivariable models demonstrated that each age decile entailed a 19% (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.10-1.29, p < 0.001) and a 10% (OR 1.1, 95% CI 1.05-1.16) increased probability for a high-risk Decipher biopsy and RP score, respectively. Aside from an obvious selection bias, data on race, family history, prostate volume, and long-term follow-up outcomes were unavailable. CONCLUSIONS These data demonstrated that elderly men with favorable pathology (IGG 1-2), might harbor more aggressive disease than younger patients based on validated GC scores. PATIENT SUMMARY The presented clinical-genomic data demonstrate that elderly patients with low-risk prostate cancer might harbor more aggressive disease than their younger counterparts. This suggests that standard well-accepted paradigm of elderly prostate cancer patients not being aggressively treated, based solely on their chronological age, might need to be reconsidered.
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
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Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Bernard B, Burnett C, Sweeney CJ, Rider JR, Sridhar SS. Impact of age at diagnosis of de novo metastatic prostate cancer on survival. Cancer 2020; 126:986-993. [PMID: 31769876 DOI: 10.1002/cncr.32630] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/26/2019] [Accepted: 10/27/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND An older age at the diagnosis of prostate cancer has been linked to worse prostate cancer-specific survival (PCSS). However, these studies were conducted before the approval of many life-prolonging drugs. This study was aimed at describing outcomes in a contemporary cohort of men diagnosed with de novo metastatic prostate cancer (mPCa) and assessing associations with the age at diagnosis while controlling for known prognostic factors. METHODS The Surveillance, Epidemiology, and End Results registry was used to identify men diagnosed with mPCa from 2004 to 2014. Men were classified by 4 age groups: ≤54, 55 to 64, 65 to 74, and ≥75 years. The median overall survival, PCSS, and restricted mean survival times for any-cause mortality and prostate cancer-specific mortality (PCSM) were calculated. Multivariable and subdistribution hazard ratios for PCSM according to age group and with controlling for race, marital status, and income were estimated. RESULTS Compared with men aged ≤54 years, men aged ≥75 years experienced a mean PCSS at 5 years that was 6.7 months shorter (95% confidence interval [CI], 5.5-7.8 months). In multivariable analyses, men aged ≥75 years had a 49% increase in the rate of PCSM in comparison with those aged ≤54 years (95% CI, 1.39-1.60). The subdistribution hazard ratio for PCSM between these groups was 1.41 (95% CI, 1.32-1.50). CONCLUSIONS Age was found to be an independent predictor of shorter PCSS in men diagnosed with de novo mPCa even in an era with more effective therapies. Further work is needed to determine the reason for poor outcomes in older men with mPCa.
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Affiliation(s)
| | - Colin Burnett
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Jennifer R Rider
- Boston University School of Public Health, Boston, Massachusetts
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Merhe A, Hout M, Abou Heidar N, El-Asmar JM, Jaafar R, Mailhac A, Tamim H, Nasr R. Is age an independent risk factor for perioperative mortality and morbidity after radical prostatectomy? Analysis of the American college of surgeons national surgical quality improvement program database. Arab J Urol 2020; 18:72-77. [PMID: 33029410 PMCID: PMC7473160 DOI: 10.1080/2090598x.2020.1721165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives To assess the safety and surgical outcomes of radical prostatectomy (RP) when looking at age as an independent risk factor of perioperative mortality and morbidity. Patients and methods A retrospective cohort study was performed using American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent a RP from 2008 to 2015 were identified. They were divided into three groups based on their age 15 group at the time of surgery. Patients’ characteristics were compared across the three following age groups: 74 years. The correlation between the three different age groups and their respective 30-day postoperative mortality and morbidity were assessed using logistic regression. Unadjusted and adjusted odds ratios (ORs) were estimated. Results A total of 43025 patients were identified, 81.7% were aged 74 years. Overall, 102 patients died in the 30-day postoperative period. Univariate and multivariate analysis showed a significant increase in the 30-day postoperative mortality from 0.1% to 0.4% to 1.3% in the three different age groups 74 years, respectively. In addition, there was a significant increase in postoperative complications in the group of patients aged >74 years. A higher risk of complications 25 related to cardiac (OR 2.18 in age group 70–74 vs OR 7.45 in age group >74 years), respiratory (OR 2.36 vs OR 5.91), neurological (OR 2.28 vs OR 3.44), wound infections (OR 1.49 vs OR 3.25), and sepsis (OR 1.54 vs OR 2.64) were seen with the youngest group taken as a reference. Conclusion Age is an independent risk factor for perioperative mortality and morbidity after RP in elderly patients. Therefore, age should be considered in the decision making of therapeutic options for patients with prostate cancer. Abbreviations BMI: body mass index; CNS: central nervous system; SIOG: International Society of Geriatric Oncology; SEER: Surveillance, Epidemiology, and End Results; ACS: American College of Surgeons; NSQIP: National Surgical Quality Improvement Program; OR: odds ratio
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Affiliation(s)
- Ali Merhe
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Hout
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib Abou Heidar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Biostatistics and Clinical Research Unit, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics and Clinical Research Unit, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
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Cui PF, Cong XF, Gao F, Yin JX, Niu ZR, Zhao SC, Liu ZL. Prognostic factors for overall survival in prostate cancer patients with different site-specific visceral metastases: A study of 1358 patients. World J Clin Cases 2020; 8:54-67. [PMID: 31970170 PMCID: PMC6962083 DOI: 10.12998/wjcc.v8.i1.54] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distant metastasis, particularly visceral metastasis (VM), represents an important negative prognostic factor for prostate cancer (PCa) patients. However, due to the lower rate of occurrence of VM, studies on these patients are relatively rare. Consequently, studies focusing on prognostic factors associated with PCa patients with VM are highly desirable. AIM To investigate the prognostic factors for overall survival (OS) in PCa patients with lung, brain, and liver metastases, respectively, and evaluate the impact of site-specific and number-specific VM on OS. METHODS Data on PCa patients with VM were extracted from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. Univariate and multivariate Cox regression analyses were used to analyze the association between clinicopathological characteristics and survival of patients with different site-specific VM. Kaplan-Meier analyses and Log-rank tests were performed to analyze the differences among the groups. RESULTS A total of 1358 PCa patients with site-specific VM were identified from 2010 to 2015. Older age (> 70 years) (P < 0.001), higher stage (T3/T4) (P = 0.004), and higher Gleason score (> 8) (P < 0.001) were found to be significant independent prognostic factors associated with poor OS in PCa patients with lung metastases. Higher stage (T3/T4) (P = 0.047) was noted to be the only independent risk factor affecting OS in PCa patients with brain metastases. Older age (> 70 years) (P = 0.010) and higher Gleason score (> 8) (P = 0.001) were associated with shorter OS in PCa patients with liver metastases. PCa patients with isolated lung metastases exhibited significantly better survival outcomes compared with PCa patients with other single sites of VM (P < 0.001). PCa patients with a single site of VM exhibited a superior OS compared with PCa patients with multiple sites of VM (P < 0.001). CONCLUSION This is the first Surveillance, Epidemiology, and End Results-based study to determine prognostic factors affecting OS in PCa patients with different site-specific VM. Clinical assessments of these crucial prognostic factors become necessary before establishing a treatment strategy for these patients with metastatic PCa.
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Affiliation(s)
- Peng-Fei Cui
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Feng Cong
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Feng Gao
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jia-Xin Yin
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zi-Ru Niu
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Song-Chen Zhao
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zi-Ling Liu
- Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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L’adénocarcinome prostatique, premier cancer chez l’homme âgé en France. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mongiat-Artus P, Paillaud E, Caillet P, Albrand G, Neuzillet Y. [Geriatric specificities of prostate cancer]. Prog Urol 2019; 29:828-839. [PMID: 31771767 DOI: 10.1016/j.purol.2019.09.002] [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: 08/26/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the epidemiology of prostate cancer (PCa) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to PCa. Recall therapeutic options and the treatment options specific to elderly patients. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, prostate cancer, diagnosis, treatment. RESULTS The median age at diagnosis for PCa is 69 years old, making PCa the very type of cancer of the elderly. The specific mortality of the disease increases with age. This translates two of its characteristics. First, a diagnosis at higher grade and stage is more common in older patients than in younger patients. Secondly, use of curative therapeutic options is less common in elderly patients than in younger patients. SIOG recommends a specific geriatric assessment for patients with PCa, which may be useful, but the need for an initial detection of cognitive disorders is open to criticism. There is no therapeutic trial, if only prospective, dedicated to elderly patients with PCa. However, decision-making in the elderly patient with PCa must pursue two goals: first, the respect of the expectations specific to each patient and secondly, the search for the global clinical benefit; goals that should not be restricted to elderly patients. CONCLUSION PCa in the elderly patient follow the current guidelines for diagnostic and for treatment. Compliance with these guidelines should eliminate both the late diagnosis and the under-treatment actually observed.
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Affiliation(s)
- P Mongiat-Artus
- Service d'urologie et unité de chirurgie et d'anesthésie ambulatoires, université Paris Diderot - université de Paris, Inserm UMR_S1165, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - E Paillaud
- Service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, université René-Descartes - université de Paris, EA 7376 épidémiologie clinique et vieillissement, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, Pierre-Bénite, France
| | - Y Neuzillet
- Service d'urologie, université de Versailles-Saint-Quentin en Yvelines, hôpital Foch, Suresnes, France
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Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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Marcucci M, Damanti S, Germini F, Apostolo J, Bobrowicz-Campos E, Gwyther H, Holland C, Kurpas D, Bujnowska-Fedak M, Szwamel K, Santana S, Nobili A, D'Avanzo B, Cano A. Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines. BMC Med 2019; 17:193. [PMID: 31660959 PMCID: PMC6819620 DOI: 10.1186/s12916-019-1434-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described. MAIN TEXT The guidelines were framed into four questions - one general and three on specific groups of interventions - all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders' values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions. CONCLUSIONS We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders' inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Nutritional Sciences Doctorate, Università degli Studi di Milano, Milan, Italy
| | - Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Joao Apostolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice - a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice - a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
| | - Holly Gwyther
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Carol Holland
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Katarzyna Szwamel
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
- Faculty of Medical Science, Opole Medical School, Opole, Poland
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Alessandro Nobili
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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Updated recommendations of the International Society of Geriatric Oncology on prostate cancer management in older patients. Eur J Cancer 2019; 116:116-136. [DOI: 10.1016/j.ejca.2019.04.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 02/08/2023]
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Systemic Treatment of Prostate Cancer in Elderly Patients: Current Role and Safety Considerations of Androgen-Targeting Strategies. Drugs Aging 2019; 36:701-717. [DOI: 10.1007/s40266-019-00677-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Filippova OT, Chi DS, Long Roche K, Sonoda Y, Zivanovic O, Gardner GJ, Tew WP, O'Cearbhaill R, Sarraf S, Sun SW, Alexander K, Korc-Grodzicki B, Shahrokni A. Geriatric co-management leads to safely performed cytoreductive surgery in older women with advanced stage ovarian cancer treated at a tertiary care cancer center. Gynecol Oncol 2019; 154:77-82. [PMID: 31078241 DOI: 10.1016/j.ygyno.2019.04.683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess fitness and outcomes in older women undergoing cytoreductive surgery for advanced ovarian cancer (OC). METHODS A prospective study of OC patients referred to Geriatrics Clinic for preoperative evaluation. All completed the electronic Rapid Fitness Assessment (eRFA) and were followed by Geriatrics Service during inpatient postoperative course, co-managed by Surgical Service. Outcomes were 30-day Intensive Care Unit (ICU) admission, emergency room (ER) visit, readmission, mortality, adverse surgical events. Descriptive statistics were used. RESULTS Forty-two women (median age 79, range 74-88), 38 with newly diagnosed advanced OC, 4 with recurrent OC, underwent cytoreductive surgery between 5/2015 and 1/2018. Preoperative age-related impairments per eRFA: high level of distress (71%), functional dependency (59%), limited social activity (59%), depression (57%), slow Time Up and Go (54%), Karnofsky Performance Score (KPS) ≤ 80 (41%), poor social support (43%), polypharmacy (35%), weight loss>10 lbs. (25%), fall history (244%), cognitive impairment (13%). Median number of comorbid conditions = 3. Among 38 newly diagnosed women, 26 (68%) had stage IIIC, 11 (29%) stage IV. Sixteen (42%) underwent primary debulking surgery, 22 (58%) neoadjuvant chemotherapy followed by interval debulking surgery. Median duration of surgery = 245.5 min (range 95-621); median hospital length of stay = 6 days (range 0-22). Optimal debulking rate = 97%, complete gross resection rate = 63%. One patient was admitted to ICU, 26% had 30-day ER visit, 10% were readmitted. Any complication, minor complication, major complication occurred in 58%, 55%, 8%, respectively. Median time from surgery to postoperative chemotherapy = 34.5 days (range 19-66). Median follow-up = 15.7 months (range 3.7-38.0), 12-month survival = 93.3%. There was no 180-day mortality. CONCLUSION Cytoreductive surgery among older women with advanced OC and frailty can be performed safely in a tertiary care center with preoperative/postoperative geriatric and surgical co-management.
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Affiliation(s)
- Olga T Filippova
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Kara Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Roisin O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Saman Sarraf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sung Wu Sun
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Koshy Alexander
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Beatriz Korc-Grodzicki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Armin Shahrokni
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
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50
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Yoon SE, Kim Y, Cho J, Kang M, Sung HH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Lee SJ, Park SH. A retrospective feasibility study of biweekly docetaxel in patients with high-risk metastatic castration-naïve prostate cancer. BMC Urol 2019; 19:30. [PMID: 31053137 PMCID: PMC6499987 DOI: 10.1186/s12894-019-0463-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Results from randomized phase III trials have shown that thrice-weekly docetaxel added to androgen-deprivation therapy (ADT) has a significant impact on the survival of patients with metastatic castration-naïve prostate cancer (mCNPC) and established early chemotherapy as part of the standard of care for high-risk disease. Controversy remains, however, because some patients experience critical toxicities related to docetaxel. The purpose of the current study was to evaluate the feasibility and adverse events of biweekly-administered docetaxel in patients with previously-untreated, high-risk mCNPC. Methods The study included 35 consecutive patients with high-risk mCNPC who received ADT plus docetaxel 40 mg/m2. Oral prednisone 5 mg twice daily was also given. Treatment was repeated every two weeks for up to 12 cycles or until disease progression or unacceptable toxicity occurred. High-risk was defined as bone metastases beyond axial skeleton and/or visceral disease. Results The included patients’ median age was 68 years (range: 31–86 years) and 17 (49%) had visceral metastases. Biweekly docetaxel was generally well-tolerated; the most commonly observed adverse events, considering those of all grades, included alopecia (74%), nail changes (42%), and constipation (31%). Hematologic adverse events were infrequent, and no patient received hematopoietic growth factors. One patient died after the fourth cycle due to respiratory failure, which occurred as a complication of pneumonia. Among the 35 patients, 28 completed the planned 12 cycles of biweekly docetaxel. Prostate-specific antigen response (> 50% decrease from baseline) was recorded in 33 patients (94%), and the radiologic response rate was 49%. Median progression-free survival was 13.6 months (95% confidence interval: 6.7–20.4). Conclusion ADT plus biweekly-administered docetaxel appeared to be tolerated and effective in patients with high-risk mCNPC.
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Affiliation(s)
- Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Youjin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jangho Cho
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byoung Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su Jin Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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