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Bates AJ, Rosser BRS, Polter EJ, Wheldon CW, Talley KMC, Haggart R, Wright M, Mitteldorf D, West W, Ross MW, Konety BR, Kohli N. Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors. Front Oncol 2022; 12:833197. [PMID: 35494011 PMCID: PMC9043609 DOI: 10.3389/fonc.2022.833197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Prostate cancer treatment has established effects on the health-related quality of life (HRQOL) of patients. While racial/ethnic differences in HRQOL have been explored in heterosexual patients, this is the first study to examine racial/ethnic differences in a cohort of sexual minority prostate cancer survivors. Methods We used data from the Restore-1 study, an online cross-sectional survey of sexual and gender minority (SGM) prostate cancer survivors in North America, to explore the association between race/ethnicity and HRQOL. General mental and physical HRQOL was assessed using the Short-Form Health Survey version 2 (SF-12). The frequency and distress of prostate cancer specific symptoms was assessed using the Expanded Prostate Cancer Composite (EPIC) scale. Multivariable linear regression was used to estimate mean differences in HRQOL between sexual minority men of color and their white, non-Hispanic counterparts after adjustment for pertinent demographic and medical characteristics. Results Among 190 participants, 23 (12%) self-identified as non-white and/or Hispanic. In unadjusted analysis, sexual minority men of color compared to their white counterparts reported worse HRQOL scores in the EPIC hormonal summary (73.8 vs. 81.8) and hormonal function (70.9 vs 80.5) domains. Clinically important differences between men of color and their white counterparts were seen in the EPIC bowel function (mean difference (MD): -4.5, 95% CI: -9.9, 0.8), hormonal summary (MD: -8.0, 95% CI: -15.6, -0.4), hormonal function (MD: -9.6, 95% CI: -17.6, -1.6), and hormonal bother (MD: -6.7, 95% CI: -14.4, 1.1) domains. After adjustment for covariates, clinically important differences persisted between men of color and white, non-Hispanic men on the hormonal summary (74.4 vs. 81.7), hormonal function (71.3 vs. 80.3), and hormonal bother (77.0 vs. 82.7) domains. Conclusions This exploratory study provides the first evidence that sexual minority men of color may have worse HRQOL outcomes compared to white, non-Hispanic sexual minority men following prostate cancer treatment.
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Affiliation(s)
- Alex J Bates
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Elizabeth J Polter
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Kristine M C Talley
- Adult and Geriatric Health, University of Minnesota School of Nursing, Minneapolis, MN, United States
| | - Ryan Haggart
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Morgan Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | | | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
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2
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Sineath RC, Blasdel G, Dy GW. Addressing urologic health disparities in sexual and gender minority communities through patient-centered outcomes research. Urology 2021; 166:66-75. [PMID: 34774931 DOI: 10.1016/j.urology.2021.08.065] [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] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 10/19/2022]
Abstract
Sexual and gender minority (SGM) communities face stigma and discrimination that impact all aspects of health. To better understand and improve their urologic health outcomes, we must study SGM patients as a distinct population and pursue research on outcomes identified as priorities to SGM communities. Patient-centered outcomes research (PCOR) is a methodology which is increasingly familiar to urologists and is crucial to adequately addressing SGM health in future urological research. We review existing literature focused on urologic outcomes of SGM populations and highlight specific PCOR initiatives built on SGM community engagement.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, Oregon.
| | - Gaines Blasdel
- Department of Urology, New York University Grossman School of Medicine, New York, New York
| | - Geolani W Dy
- Department of Urology, Oregon Health & Science University, Portland, Oregon
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3
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Abstract
Prostate cancer is the second most common cause of cancer-related death in men in the USA, but the effect of prostate cancer diagnosis and treatment on men in a sexual minority group, including men who have sex with men and transgender women, is poorly understood. Efforts to study this population are complicated, as cancer registries do not routinely collect information on sexual orientation. As a result, epidemiological data regarding this population have come from small studies that have included disparate rates of prostate cancer screening, diagnosis and treatment. Qualitative studies indicate that prostate cancer is experienced differently by sexual minorities, with distinct health-care needs that arise owing to differences in sexual practices, social support systems and relationships with the medical community. Notably, sexual minorities have been reported to experience poorer health-related quality of life outcomes than heterosexual men, and tend to have less robust social support systems, experience increased psychological distress caused by sexual dysfunction (areas of which are unmeasured after treatment), experience isolation within the health-care system and express increased levels of dissatisfaction with treatment. The incidence of prostate cancer actually seems to be decreased in men from sexual minorities living with HIV, despite there being no differences in screening and treatment, with poor cancer-specific mortality. Although the literature on patients with prostate cancer in men from sexual minority groups has historically been sparse, peer-reviewed research in this area has grown considerably during the past decade and has become an important field of study.
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Rosser BRS, Hunt SL, Capistrant BD, Kohli N, Konety BR, Mitteldorf D, Ross MW, Talley KM, West W. Understanding Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women: A Review of the Literature. CURRENT SEXUAL HEALTH REPORTS 2019; 11:430-441. [PMID: 31929765 PMCID: PMC6953377 DOI: 10.1007/s11930-019-00234-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW a)Prostate cancer in sexual and gender minorities is an emerging medical and public health concern. The purpose of this review is to summarize the state of the science on prostate cancer in gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). We undertook a literature review of all publications on this topic through February 2017. With 88 unique papers (83) on prostate cancer in GBM and 5 case reports of prostate cancer in TGW), a small but robust literature has emerged. RECENT FINDINGS b)The first half of this review critiques the literature to date, identifying gaps in approaches to study. The second half summarizes the key findings in eleven areas. In light of this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men, but they are diagnosed with prostate cancer at about the same rate. SUMMARY c)Compared to other men, GBM have poorer urinary, bowel, and overall quality-of-life outcomes but better sexual outcomes after treatment; all these findings need more research. Prostate cancer in TGW remains rare and under researched, as the literature is limited to single-case clinical reports.
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Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology & Community Health, School of
Public Health, University of Minnesota
| | - Shanda L. Hunt
- Education and Research Services, University of
Minnesota
| | | | - Nidhi Kohli
- Department of Educational Psychology, University of
Minnesota, Minneapolis, MN
| | | | | | - Michael W. Ross
- Department of Family Medicine & Community Health,
Medical School, University of Minnesota, Minneapolis, MN
| | | | - William West
- Department of Writing Studies, University of
Minnesota
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5
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Impact of Radiation Therapy Dose Escalation on Prostate Cancer Outcomes and Toxicities. Am J Clin Oncol 2019; 41:409-415. [PMID: 27014930 DOI: 10.1097/coc.0000000000000285] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Freedom from biochemical failure (FFBF) is a common primary outcome of randomized-controlled trials of prostate cancer (PCa). We aimed to determine how increasing the PCa biologically equivalent dose (BED) of external radiation therapy (RT) is correlated with FFBF and overall patient outcomes: overall survival (OS), distant metastasis (DM), and cancer-specific mortality (CSM); as well as genitourinary (GU), and gastrointestinal toxicities. MATERIALS AND METHODS We performed a meta-analysis of 6884 PCa patients from 12 randomized-controlled trials of external beam RT. Mixed effects regression models were used to estimate weighted linear relationships between BED and observed percentages of 5- and 10-year outcomes. For toxicities, a subset analysis of using 3-dimensional conformal RT (3D-CRT) versus intensity-modulated RT (IMRT) was performed. RESULTS Increasing BED correlated with improved FFBF: 10-year absolute improvement of 9.6% and 7.2% for low-risk and intermediate-risk patients, respectively (P<0.05); but not with improvement of OS, DM, or CSM at either time point. BED escalation was not correlated with increased acute toxicities; it was correlated with increased late gastrointestinal toxicities in patients treated with 3D-CRT (1.5% increase over BED range, P<0.01). IMRT patients had significantly fewer late toxicities, despite being treated at higher BED. CONCLUSIONS RT BED escalation has resulted in significantly improved PCa FFBF at up to 10 years; but not with improvement in OS, DM, or CSM. Thus, FFBF is a poor surrogate of overall patient outcomes for trials of RT. Late toxicities were less frequent with IMRT than with 3D-CRT, even at higher BED.
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Crawford-Williams F, March S, Goodwin BC, Ralph N, Galvão DA, Newton RU, Chambers SK, Dunn J. Interventions for prostate cancer survivorship: A systematic review of reviews. Psychooncology 2018; 27:2339-2348. [DOI: 10.1002/pon.4888] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions; University of Southern Queensland; Springfield Central Queensland Australia
| | - Sonja March
- Institute for Resilient Regions; University of Southern Queensland; Springfield Central Queensland Australia
- School of Psychology; University of Southern Queensland; Springfield Central Queensland Australia
| | - Belinda C. Goodwin
- Institute for Resilient Regions; University of Southern Queensland; Springfield Central Queensland Australia
| | - Nicholas Ralph
- Institute for Resilient Regions; University of Southern Queensland; Springfield Central Queensland Australia
- School of Nursing and Midwifery; University of Southern Queensland; Toowoomba Queensland Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute; Edith Cowan University; Joondalup Western Australia Australia
- School of Medical and Health Sciences; Edith Cowan University; Joondalup Western Australia Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute; Edith Cowan University; Joondalup Western Australia Australia
- School of Medical and Health Sciences; Edith Cowan University; Joondalup Western Australia Australia
| | - Suzanne K. Chambers
- Exercise Medicine Research Institute; Edith Cowan University; Joondalup Western Australia Australia
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
- Faculty of Health; University of Technology Sydney; Sydney New South Wales Australia
- Cancer Research Centre; Cancer Council Queensland; Fortitude Valley Queensland Australia
| | - Jeff Dunn
- Institute for Resilient Regions; University of Southern Queensland; Springfield Central Queensland Australia
- Faculty of Health; University of Technology Sydney; Sydney New South Wales Australia
- Cancer Research Centre; Cancer Council Queensland; Fortitude Valley Queensland Australia
- School of Medicine; Griffith University; Brisbane Queensland Australia
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Zaorsky NG, Lee CT, Zhang E, Galloway TJ. Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis. Radiother Oncol 2018; 126:386-393. [PMID: 29370985 PMCID: PMC7548033 DOI: 10.1016/j.radonc.2017.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. MATERIALS AND METHODS Studies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED3) and cosmetic outcomes. RESULTS A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED3 of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED3 >100 Gy. No difference in "poor" cosmesis was noted at any BED3. LR was <7% for both at one year. CONCLUSION BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
| | - Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
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8
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Thomas C, Wootten AC, Robinson P, Law PCF, McKenzie DP. The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer. Eur J Cancer Care (Engl) 2018; 27:e12827. [PMID: 29461652 DOI: 10.1111/ecc.12827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/27/2022]
Abstract
Prostate cancer (PCa) poses a large health burden globally. Research indicates that men experience a range of psychological challenges associated with PCa including changes to identity, self-esteem and body image. The ways in which sexual orientation plays a role in the experience of PCa, and the subsequent impact on quality of life (QoL), body image and self-esteem have only recently been addressed. By addressing treatment modality, where participant numbers were sufficient, we also sought to explore whether gay (homosexual) men diagnosed with PCa (PCaDx) and with a primary treatment modality of surgery would report differences in body image and self-esteem compared with straight (heterosexual) men with PCaDx with a primary treatment modality of surgery, compared with gay and straight men without PCaDx. The results of our study identified overall differences with respect to PCaDx (related to urinary function, sexual function and health evaluation), and sexual orientation (related to self-esteem), rather than interactions between sexual orientation and PCaDx. Gay men with PCaDx exhibited higher levels of urinary functioning than straight men with PCaDx, the difference being reversed for gay and straight men without PCaDx; but this result narrowly failed to achieve statistical significance, suggesting a need for further research, with larger samples.
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Affiliation(s)
- C Thomas
- Epworth Prostate Centre, Epworth HealthCare, Richmond, Victoria, Australia
| | - A C Wootten
- Smiling Mind, Melbourne, Victoria, Australia
| | - P Robinson
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - P C F Law
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D P McKenzie
- Epworth Research Institute, Epworth HealthCare, Richmond, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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9
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Zaorsky NG, Lee CT, Zhang E, Keith SW, Galloway TJ. Hypofractionated radiation therapy for basal and squamous cell skin cancer: A meta-analysis. Radiother Oncol 2017; 125:13-20. [PMID: 28843727 PMCID: PMC7534946 DOI: 10.1016/j.radonc.2017.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE To characterize the cosmetic outcomes and local recurrence (LR) rates of various hypofractionated radiation therapy (RT) regimens for skin basal and squamous cell cancers (BCCs/SCCs). METHODS A PICOS/PRISMA/MOOSE selection protocol was performed to identify 344 articles published between 1985-2016 evaluating patients with T1-2 N0 SCCs/BCCs treated with definitive RT. Biologically equivalent doses with α/β=3 (BED3s) were calculated. The primary endpoint was post-treatment cosmesis. Mixed effects regression models were used to estimate weighted linear relationships between BED3 and cosmetic outcomes. RESULTS A total of 21 studies were identified detailing the treatment of 9729 skin BCC/SCC patients, across seven countries, with external beam RT (n=9255) or brachytherapy (n=474). Median follow-up was 36months (range: 12-77). Median dose was 45Gy/11 fractions (interquartile range: 37.5Gy/6-55Gy/18) at 4Gy/fraction (interquartile range: 2.5-6Gy); most hypofractionated 18.75Gy/1. There was a trend to decreased "good" cosmesis with higher total dose: -3.4% "good" cosmesis/10Gy BED3, p=0.01. Similarly, there was a trend to increased "fair" cosmesis with higher dose: +3.8% "fair" cosmesis/10Gy BED3,p=0.006. At a BED3 of 100Gy, the expected rate of "good" cosmesis is 79% (95% confidence interval: 70%, 88%). Hypofractionated schedules produced similar cosmesis to conventionally fractionated schedules, at the same BED3. Fewer than 8% of patients experienced "poor" cosmesis, independent of dose or fractionation regimen. CONCLUSION Hypofractionated RT has favorable cosmesis for patients with skin BCCs/SCCs. We recommend clinicians consider these commonly-used regimens, which all have BED3 of ∼100Gy: 50Gy/15 fractions, 36.75Gy/7 fractions, or 35Gy/5 fractions, as they result in "good" cosmesis in 80% of patients.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
| | - Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
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10
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The Missing Pieces in Reporting of Randomized Controlled Trials of External Beam Radiation Therapy Dose Escalation for Prostate Cancer. Am J Clin Oncol 2017; 39:321-6. [PMID: 27322694 DOI: 10.1097/coc.0000000000000313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Randomized controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost-effectiveness of a treatment. For many patients, cancer is a chronic illness; RCTs evaluating treatments for indolent cancers must evolve to facilitate medical decision-making, as "concrete" patient outcomes (eg, survival) will likely be excellent independent of the intervention, and detecting a difference between trial arms may be impossible. In this commentary, we articulate 9 recommendations that we hope future clinical trialists and funding agencies (including those under the National Cancer Institute) will take into consideration when planning RCTs to help guide subsequent interpretation of results and clinical decision making, based on RCTs of external beam radiation therapy dose escalation for the most common indolent cancer in men, that is, prostate cancer. We recommend routinely reporting: (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics (eg, number of centers involved, type of facilities, yearly hospital volumes). We discuss how these factors independently affect patient outcomes and toxicities; future clinicians and governing organizations should consider this information to plan RCTs accordingly (to maximize patient accrual and total n), select appropriate endpoints (eg, toxicity, quality of life, sexual function), actively monitor RCTs, and report results so as to identify the optimal treatment among subpopulations.
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11
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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12
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Hoyt MA, Frost DM, Cohn E, Millar BM, Diefenbach MA, Revenson TA. Gay men's experiences with prostate cancer: Implications for future research. J Health Psychol 2017; 25:298-310. [PMID: 28810471 DOI: 10.1177/1359105317711491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Gay men's experiences with prostate cancer and its impact on health-related quality of life are poorly understood. This qualitative study explored gay men's experience with prostate cancer with a focus on the emotional, physical, and sexual impact of cancer; support needs; and healthcare interactions. Three semi-structured focus groups of gay men with prostate cancer were conducted. A conventional content analytic approach was used to identify six primary content areas that described poignant aspects of the men's experience with prostate cancer: minority stress, intimacy and sexuality concerns, impact on life outlook, healthcare experiences, social support and the gay community, and intersectional identities.
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Affiliation(s)
- Michael A Hoyt
- Hunter College and the Graduate Center, The City University of New York, USA
| | | | | | - Brett M Millar
- Hunter College and the Graduate Center, The City University of New York, USA
| | | | - Tracey A Revenson
- Hunter College and the Graduate Center, The City University of New York, USA
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13
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Zaorsky NG, Churilla TM, Ruth K, Hayes SB, Sobczak ML, Hallman MA, Smaldone MC, Chen DY, Horwitz EM. Men's health supplement use and outcomes in men receiving definitive intensity-modulated radiation therapy for localized prostate cancer. Am J Clin Nutr 2016; 104:1583-1593. [PMID: 27797706 PMCID: PMC5118729 DOI: 10.3945/ajcn.115.119958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/19/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Approximately 50% of newly diagnosed cancer patients start taking dietary supplements. Men's health supplements (MHSs), which we define as supplements that are specifically marketed with the terms men's health and prostate health (or similar permutations), are often mislabeled as having potential anticancer benefits. OBJECTIVE We evaluated the effects of MHSs on patient outcomes and toxicities in patients who were undergoing definitive intensity-modulated radiation therapy (IMRT) for localized prostate cancer. DESIGN This retrospective analysis included patients who were being treated at a National Cancer Institute-designated comprehensive cancer center and consented to have information stored in a prospective database. MHSs were queried online. Outcome measures were freedom from biochemical failure (FFBF) (biochemical failure was defined with the use of the prostate-specific antigen nadir + 2-ng/mL definition), freedom from distant metastasis (FFDM), cancer-specific survival (CSS), and overall survival (OS) as well as toxicities. Kaplan-Meier analysis, log-rank tests, Fine and Gray competing-risk regression (to adjust for patient and lifestyle factors), and Cox models were used. RESULTS From 2001 to 2012, 2207 patients were treated with IMRT with a median dose of 78 Gy, and a median follow-up of 46 mo. Of these patients, 43% were low risk, 37% were intermediate risk, and 20% were high risk; 10% used MHSs. MHSs contained a median of 3 identifiable ingredients (range: 0-78 ingredients). Patients who were taking an MHS compared with those who were not had improved 5-y OS (97% compared with 92%, respectively; P = 0.01), but there were no differences in the FFBF (94% compared with 89%, respectively; P = 0.12), FFDM (96% compared with 97%, respectively; P = 0.32), or CSS (100% compared with 99%, respectively; P = 0.22). The unadjusted association between MHS use and improved OS was attenuated after adjustment for patient lifestyle factors and comorbidities. There was no difference in toxicities between the 2 groups (late-grade 3-4 genitourinary <3%; gastrointestinal <4%). CONCLUSION The use of MHSs is not associated with outcomes or toxicities.
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Affiliation(s)
| | | | - Karen Ruth
- Biostatistics and Bioinformatics Facility, and
| | | | | | | | - Marc C Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - David Yt Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Avkshtol V, Dong Y, Hayes SB, Hallman MA, Price RA, Sobczak ML, Horwitz EM, Zaorsky NG. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer. Res Rep Urol 2016; 8:145-58. [PMID: 27574585 PMCID: PMC4993397 DOI: 10.2147/rru.s58262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years) and acute and late toxicity (<6% grade 3–4 late toxicities). Other outcomes (eg, overall and cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.
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Affiliation(s)
- Vladimir Avkshtol
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Yanqun Dong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark L Sobczak
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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15
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Zaorsky NG, Shaikh T, Murphy CT, Hallman MA, Hayes SB, Sobczak ML, Horwitz EM. Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer. Cancer Treat Rev 2016; 48:50-60. [PMID: 27347670 DOI: 10.1016/j.ctrv.2016.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/13/2023]
Abstract
We review radiation therapy (RT) options available for prostate cancer, including external beam (EBRT; with conventional fractionation, hypofractionation, stereotactic body RT [SBRT]) and brachytherapy (BT), with an emphasis on the outcomes, toxicities, and contraindications for therapies. PICOS/PRISMA methods were used to identify published English-language comparative studies on PubMed (from 1980 to 2015) that included men treated on prospective studies with a primary endpoint of patient outcomes, with ⩾70 patients, and ⩾5year median follow up. Twenty-six studies met inclusion criteria; of these, 16 used EBRT, and 10 used BT. Long-term freedom from biochemical failure (FFBF) rates were roughly equivalent between conventional and hypofractionated RT with intensity modulation (evidence level 1B), with 10-year FFBF rates of 45-90%, 40-60%, and 20-50% (for low-, intermediate-, and high-risk groups, respectively). SBRT had promising rates of BF, with shorter follow-up (5-year FFBF of >90% for low-risk patients). Similarly, BT (5-year FFBF for low-, intermediate-, and high-risk patients have generally been >85%, 69-97%, 63-80%, respectively) and BT+EBRT were appropriate in select patients (evidence level 1B). Differences in overall survival, distant metastasis, and cancer specific mortality (5-year rates: 82-97%, 1-14%, 0-8%, respectively) have not been detected in randomized trials of dose escalation or in studies comparing RT modalities. Studies did not use patient-reported outcomes, through Grade 3-4 toxicities were rare (<5%) among all modalities. There was limited evidence available to compare proton therapy to other modalities. The treatment decision for a man is usually based on his risk group, ability to tolerate the procedure, convenience for the patient, and the anticipated impact on quality of life. To further personalize therapy, future trials should report (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education status; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Talha Shaikh
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Colin T Murphy
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark L Sobczak
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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16
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Simon Rosser B, Merengwa E, Capistrant BD, Iantaffi A, Kilian G, Kohli N, Konety BR, Mitteldorf D, West W. Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men: A Review. LGBT Health 2016. [DOI: 10.1089/lgbt.2015.0092] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- B.R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Enyinnaya Merengwa
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Benjamin D. Capistrant
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Alex Iantaffi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Gunna Kilian
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota
| | | | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, Minnesota
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17
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Zaorsky NG, Hallman MA, Smaldone MC. Radiation therapy to the primary tumor in locally advanced prostate cancer is not "closing the barn door after the horse has bolted". ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:274. [PMID: 26605320 DOI: 10.3978/j.issn.2305-5839.2015.09.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Nicholas G Zaorsky
- 1 Department of Radiation Oncology, 2 Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Mark A Hallman
- 1 Department of Radiation Oncology, 2 Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Marc C Smaldone
- 1 Department of Radiation Oncology, 2 Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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18
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Zaorsky NG, Doyle LA, Hurwitz MD, Dicker AP, Den RB. Do theoretical potential and advanced technology justify the use of high-dose rate brachytherapy as monotherapy for prostate cancer? Expert Rev Anticancer Ther 2014; 14:39-50. [PMID: 24124755 DOI: 10.1586/14737140.2013.836303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low-dose rate brachytherapy (LDR-BT), involving implantation of radioactive seeds into the prostate, is an established monotherapy for most low-risk and select intermediate- and high-risk prostate cancer patients. High-dose rate brachytherapy (HDR-BT) is an advanced technology theorized to be more advantageous than LDR-BT from a radiobiological and radiophysics perspective, to the patient himself, and in terms of resource allocation. Studies of HDR-BT monotherapy have encouraging results in terms of biochemical control, patient survival, treatment toxicity and erectile preservation. However, there are still certain limitations that preclude recommending HDR-BT monotherapy for prostate cancer outside the setting of a clinical trial. HDR-BT monotherapy should be considered experimental at present.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Murphy AB, Bhatia R, Martin IK, Klein DA, Hollowell CMP, Nyame Y, Dielubanza E, Achenbach C, Kittles RA. Are HIV-infected men vulnerable to prostate cancer treatment disparities? Cancer Epidemiol Biomarkers Prev 2014; 23:2009-2018. [PMID: 25063519 DOI: 10.1158/1055-9965.epi-14-0614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV-infected (HIV(+)) men face cancer treatment disparities that impact outcome. Prostate cancer treatment and treatment appropriateness in HIV(+) men are unknown. METHODS We used electronic chart review to conduct a retrospective cohort study of 43 HIV(+) cases with prostate cancer and 86 age- and race-matched HIV-uninfected (HIV(-)) controls with prostate cancer, ages 40 to 79 years, from 2001 to 2012. We defined treatment appropriateness using National Comprehensive Cancer Network guidelines and the Charlson comorbidity index (CCI) to estimate life expectancy. RESULTS Median age was 59.5 years at prostate cancer diagnosis. Median CD4(+) T-cell count was 459.5 cells/mm(3), 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy was the primary treatment for 39.5% of HIV(+) and 71.0% of HIV(-) men (P = 0.004). Only 16.3% of HIV(+) versus 57.0% of HIV(-) men received open radical prostatectomy (P < 0.001). HIV(+) men received more radiotherapy (25.6% vs. 16.3%, P = 0.13). HIV was negatively associated with open radical prostatectomy (OR = 0.03, P = 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV(+) men received appropriate treatment (89.2% vs. 100%, P = 0.003), due to four overtreated HIV(+) men. Excluding AIDS from the CCI still resulted in fewer HIV(+) men receiving appropriate treatment (94.6% vs. 100%, P = 0.03). CONCLUSION Prostate cancer in HIV(+) men is largely appropriately treated. Under- or overtreatment may occur from difficulties in life expectancy estimation. HIV(+) men may receive more radiotherapy and fewer radical prostatectomies, specifically open radical prostatectomies. IMPACT Research on HIV/AIDS survival indices and etiologies and outcomes of this prostate cancer treatment disparity in HIV(+) men are needed.
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Affiliation(s)
- Adam B Murphy
- Department of Urology, Northwestern University, Chicago, IL
| | - Ramona Bhatia
- Institute for Public Health and Medicine, Northwestern University, Chicago, IL
| | - Iman K Martin
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA
| | - David A Klein
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Courtney M P Hollowell
- Department of Surgery, Division of Urology, Cook County Health and Hospitals System, Chicago, IL
| | - Yaw Nyame
- Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Chad Achenbach
- Department of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, IL
| | - Rick A Kittles
- Institute of Human Genetics, University of Illinois at Chicago, Chicago, IL
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20
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Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W, Salner AL, Zelefsky MJ, Aragon-Ching JB, Slovin SF, Wittmann DA, Hoyt MA, Sinibaldi VJ, Chodak G, Pratt-Chapman ML, Cowens-Alvarado RL. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin 2014; 64:225-49. [PMID: 24916760 DOI: 10.3322/caac.21234] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
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Affiliation(s)
- Ted A Skolarus
- Assistant Professor of Urology, Department of Urology, University of Michigan, Research Investigator, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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21
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Zaorsky NG, Den RB, Doyle LA, Dicker AP, Hurwitz MD. Combining theoretical potential and advanced technology in high-dose rate brachytherapy boost therapy for prostate cancer. Expert Rev Med Devices 2014; 10:751-63. [PMID: 24195459 DOI: 10.1586/17434440.2013.841347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
External beam radiation therapy (EBRT) combined with brachytherapy (BT) is an attractive treatment option for select patients with clinically localized prostate cancer. Either low- or high-dose rate BT may be combined with EBRT ('LDR-BT boost,' 'HDR-BT boost,' respectively). HDR-BT boost has potential theoretical benefits over LDR-BT boost or external beam radiation therapy monotherapy in terms of radiobiology, radiophysics and patient convenience. Based on prospective studies in this review, freedom from biochemical failure (FFBF) rates at 5 years for low-, intermediate- and high-risk patients have generally been 85-100%, 68-97%, 63-85%, respectively; late Radiotherapy and Oncology Group Grades 3 and 4 genitourinary and gastrointestinal toxicities are seen in <8% of patients. HDR-BT boost is now a relatively well-established treatment modality for certain intermediate-risk and high-risk prostate cancer patients, though limitations exist in drawing conclusions from the currently published studies.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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22
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High dose rate brachytherapy boost for prostate cancer: A systematic review. Cancer Treat Rev 2014; 40:414-25. [DOI: 10.1016/j.ctrv.2013.10.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/10/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022]
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23
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Yücebaş SC, Aydın Son Y. A prostate cancer model build by a novel SVM-ID3 hybrid feature selection method using both genotyping and phenotype data from dbGaP. PLoS One 2014; 9:e91404. [PMID: 24651484 PMCID: PMC3961262 DOI: 10.1371/journal.pone.0091404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 02/12/2014] [Indexed: 01/11/2023] Open
Abstract
Through Genome Wide Association Studies (GWAS) many Single Nucleotide Polymorphism (SNP)-complex disease relations can be investigated. The output of GWAS can be high in amount and high dimensional, also relations between SNPs, phenotypes and diseases are most likely to be nonlinear. In order to handle high volume-high dimensional data and to be able to find the nonlinear relations we have utilized data mining approaches and a hybrid feature selection model of support vector machine and decision tree has been designed. The designed model is tested on prostate cancer data and for the first time combined genotype and phenotype information is used to increase the diagnostic performance. We were able to select phenotypic features such as ethnicity and body mass index, and SNPs those map to specific genes such as CRR9, TERT. The performance results of the proposed hybrid model, on prostate cancer dataset, with 90.92% of sensitivity and 0.91 of area under ROC curve, shows the potential of the approach for prediction and early detection of the prostate cancer.
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Affiliation(s)
- Sait Can Yücebaş
- Medical Informatics Department, Graduate School of Informatics, Middle East Technical University. Ankara, Turkey
| | - Yeşim Aydın Son
- Medical Informatics Department, Graduate School of Informatics, Middle East Technical University. Ankara, Turkey
- Bioinformatics Graduate Program, Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
- * E-mail:
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24
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Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol 2013; 10:565-79. [DOI: 10.1038/nrurol.2013.185] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Wassersug RJ, Lyons A, Duncan D, Dowsett GW, Pitts M. Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer. Urology 2013; 82:565-71. [PMID: 23768520 DOI: 10.1016/j.urology.2013.04.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment. METHODS Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries. RESULTS There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04). CONCLUSION This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.
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Affiliation(s)
- Richard J Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
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