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Orrason AW, Styrke J, Garmo H, Stattin P. Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden. BJU Int 2023; 131:486-493. [PMID: 36088648 DOI: 10.1111/bju.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. PATIENTS AND METHODS Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. RESULTS Both no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5-19%) were estimated to have either no evidence or moderate evidence of PCa progression. CONCLUSIONS Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.
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Affiliation(s)
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Alam MU, Kumar J, Norez D, Woolfe J, Tanneru K, Jazayeri SB, Bazargani S, Thomas D, Gautam S, Costa J, Bandyk M, Ganapathi HP, Koochekpour S, Balaji KC. Natural history, and impact of surgery and radiation on survival outcomes of men diagnosed with low-grade prostate cancer at ≤ 55 years of age: a 25-year follow-up of > 60,000 men. Int Urol Nephrol 2023; 55:295-300. [PMID: 36171482 DOI: 10.1007/s11255-022-03363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Low-grade prostate cancer has low mortality rates at 10 years; however, it is unclear if the response is sustained for up to 25 years of follow-up. METHODS Using Surveillance, Epidemiology, and End Results database, the overall and cancer-specific mortality rates were compared among men ≤ 55 years of age diagnosed with low-grade prostate cancer that either had radical prostatectomy, radiotherapy, or no known treatment. RESULTS Of the 62,772 men diagnosed with low-grade prostate cancer between 1975 and 2016, about 60%, 20% and 20% of men underwent radical prostatectomy, radiotherapy, and no known treatment, respectively. At a median follow-up of 10 years, almost 2% and 7% of men died of prostate cancer and other causes, respectively. The overall mortality was significantly better in radical prostatectomy group compared to no known treatment group (HR 1.99, CI 1.84-2.15, P value < 0.001), but not between the radiotherapy and no known treatment groups. Moreover, the overall and cancer-specific mortality rates in the radiotherapy group were almost two and three times compared to the radical prostatectomy group, respectively (HR 2.15, CI 2.01-2.29, P value < 0.001 for overall mortality and HR 2.87, CI 2.5-3.29, P value < 0.001 for cancer-specific mortality). CONCLUSIONS The study confirms low mortality rates in men diagnosed with low-grade prostate cancer for over 25 years' follow-up. While radical prostatectomy improves survival significantly compared to no known treatment, radiotherapy is associated with an increase in overall and cancer-specific mortality, which may be related to long-term toxicities.
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Affiliation(s)
- Muhammad Umar Alam
- Department of Urology, Armstrong County Memorial Hospital, Kittanning, PA, 16201, USA.
| | - Jatinder Kumar
- Department of Urology, Armstrong County Memorial Hospital, Kittanning, PA, 16201, USA
| | - Daniel Norez
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Jennifer Woolfe
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Karthik Tanneru
- Department of Urology, Medical University of South Carolina, Florence, South Carolina, USA
| | - Seyed Behzad Jazayeri
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Devon Thomas
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Shiva Gautam
- Department of Biostatistics, University of Florida, Jacksonville, FL, USA
| | - Joseph Costa
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - Mark Bandyk
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | | | - Shahriar Koochekpour
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
| | - K C Balaji
- Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA
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Innos K, Paapsi K, Alas I, Baum P, Kivi M, Kovtun M, Okas R, Pokker H, Rajevskaja O, Rautio A, Saretok M, Valk E, Žarkovski M, Denissov G, Lang K. Evidence of overestimating prostate cancer mortality in Estonia: a population-based study. Scand J Urol 2022; 56:359-364. [PMID: 36073064 DOI: 10.1080/21681805.2022.2119274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prostate cancer (PC) mortality statistics in Estonia has shown inconsistencies with incidence and survival trends. The aim of this population-based study was to assess the accuracy of reporting PC as the underlying cause of death and estimate the effect of misattribution in assigning cause of death on PC mortality rates. MATERIAL AND METHODS The Estonian Causes of Death Registry (CoDR) and Cancer Registry provided data on all men in Estonia who died in 2017 and had a mention of PC on any field of the death certificate or had a lifetime diagnosis of PC. A blinded review of medical records was conducted by an expert panel to ascertain whether the underlying cause was PC or other death. We estimated the agreement between the underlying causes of death registered at the CoDR and those ascertained by medical review and calculated corrected mortality rates. RESULTS The study population included 655 deaths. Among 277 PC deaths registered at CoDR, 164 (59%) were verified by medical review. Among 378 other deaths registered at CoDR, 17 (5%) were ascertained as PC deaths by medical review. In total, the number of PC deaths decreased from 277 to 181 and the corrected age standardized (world) mortality rate decreased from 20 to 13 per 100 000 (1.5-fold overestimation, 95% confidence interval 1.2-1.9). CONCLUSIONS PC mortality statistics in Estonia should be interpreted with caution and possible overestimation considered when making policy decisions. Quality assurance mechanisms should be reinforced in the whole death certification process.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Indrek Alas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Peep Baum
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Martin Kivi
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Mihhail Kovtun
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rauno Okas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Helis Pokker
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Olga Rajevskaja
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Mikk Saretok
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Elari Valk
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Gleb Denissov
- Causes of Death Registry, National Institute for Health Development, Tallinn, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Detterbeck FC, Blasberg JD, Woodard GA, Decker RH, Kumbasar U, Park HS, Mase VJ, Bade BC, Li AX, Brandt WS, Madoff DC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 1: a guide to decision-making. J Thorac Dis 2022; 14:2340-2356. [PMID: 35813719 PMCID: PMC9264102 DOI: 10.21037/jtd-21-1823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/21/2022] [Indexed: 12/02/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, Stereotactic Body Radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods Based on a systematic review from 2000-2021, evidence regarding relevant outcomes was assembled, with attention to aspects of applicability, uncertainty and effect modifiers. A framework was developed to present this information a format that enhances decision-making at the point of care for individual patients. Results While patients often cross over several boundaries, the evidence fits into categories of healthy patients, compromised patients, and favorable tumors. In healthy patients with typical (i.e., solid spiculated) lung cancers, the impact on long-term outcomes is the major driver of treatment selection. This is only slightly ameliorated in older patients. In compromised patients increasing frailty accentuates short-term differences and diminishes long-term differences especially when considering non-surgical vs. surgical approaches; nuances of patient selection (technical treatment feasibility, anticipated risk of acute toxicity, delayed toxicity, and long-term outcomes) as well as patient values are increasingly influential. Favorable (less-aggressive) tumors generally have good long-term outcomes regardless of the treatment approach. Discussion A framework is provided that organizes the evidence and identifies the major drivers of decision-making for an individual patient. This facilitates blending available evidence and clinical judgment in a flexible, nuanced manner that enhances individualized clinical care.
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Affiliation(s)
| | - Justin D. Blasberg
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Henry S. Park
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Cardiothoracic Surgery, Washington University School of Medicine, St louis, MO, USA
| | - David C. Madoff
- Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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Alam MU, Kumar J, Norez D, Tanneru K, Jazayeri SB, Bazargani S, Costa J, Bandyk M, Ganapathi HP, Koochekpour S, Gautam S, Balaji KC. Pathology grade influences competing mortality risks in elderly men with prostate cancer. Urol Oncol 2021; 39:493.e1-493.e7. [PMID: 33353870 DOI: 10.1016/j.urolonc.2020.12.004] [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: 09/10/2020] [Revised: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent guidelines recommend active management of prostate cancer (CaP), especially high-risk disease, in elderly men. However, descriptive data from a large cohort with extended follow up on the risk of death from CaP in men diagnosed over 70 years of age and its relationship to Gleason score (GS) and serum prostate specific antigen (PSA) level is lacking. Using the Surveillance, Epidemiology, and End Results database, we evaluated the influence of GS and serum PSA levels on the risks of mortality from PC (PCM) and mortality from other causes in localized (LPC) and metastatic (MPC) disease in elderly population. METHODS Men diagnosed with PC over 70 years of age between 2004 and 2016 were divided into LPC and MPC groups, categorized by age: 70-74, 75-79, 80-84, 85-89, and ≥90 years and stratified by GS <7, 7, and >7, and serum PSA level <4, 4-10, 10-20, 20-50, and >50 ng/mL. Competing risk estimates for PCM and mortality from other causes were generated for both groups. RESULTS Of the 85,649 men, 85.5 % were LPC at diagnosis. Overall, at a median follow up of 4 years, 15% of the men had died including a third from PC. While <15% of men with GS ≤7 died from PC, the PCM was >30% in men with GS >7 in LPC group, which accounted for almost half of total deaths for age 70-84 years. The GS >7 was also significantly associated with PCM in men with MPC. Furthermore, PCM directly correlated with serum PSA levels, with mortality rates reaching up to 50% and 70% for PSA >50 ng/dl for LPC and MPC, respectively. CONCLUSIONS There is a substantial risk of dying in men diagnosed with LPC over 70 years of age with GS >7 or a serum PSA >20 ng/mL. Furthermore, the risk for death for MPC directly correlated with GS with PCM increasing from 10%-30% for GS ≤7 to >50% for GS >7. The data, in conjunction with other clinical parameters such as comorbidities could be used to counsel elderly men on management options of PC for both localized and metastatic PC.
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Affiliation(s)
| | - Jatinder Kumar
- Department of Urology, University of Florida, Jacksonville, FL
| | - Daniel Norez
- Center for Data Solutions, University of Florida, Jacksonville, FL
| | - Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, FL
| | | | | | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, FL
| | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, FL
| | | | | | - Shiva Gautam
- Center for Data Solutions, University of Florida, Jacksonville, FL
| | - K C Balaji
- Department of Urology, University of Florida, Jacksonville, FL
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Rasul R, Golden A, Feuerstein MA. Prostate cancer risk group is associated with other-cause mortality in men with localized prostate cancer. Can Urol Assoc J 2020; 14:E507-E513. [PMID: 32432539 DOI: 10.5489/cuaj.6324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Informed decision-making in localized prostate cancer must consider the natural history of the disease, risks of treatment, and the competing risks from other causes. Other-cause mortality has often been associated with comorbidity or treatment-related side effects. We aimed to examine the association between prostate cancer aggressiveness and other-cause mortality. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)18 registries, patients diagnosed with localized prostate cancer between 2004 and 2015 were identified. Patients were categorized into low-, intermediate- and high-risk groups. Vital status, death due to prostate cancer, and death due to other causes were based on death certificate information. Survival analyses were performed to assess the association between prostate cancer risk group and mortality while adjusting for demographic variables, year of diagnosis, and initial therapy. RESULTS A total of 464 653 patients were identified with a median followup of 5.4 years. Cardiovascular disease was the most common cause of mortality during the study period. Compared to low-risk patients, intermediate- and high-risk patients had a higher risk of mortality from other cancers, cardiovascular disease, and other causes of death regardless of initial treatment. Men who underwent surgery as initial therapy had lower cumulative mortality rates compared to those with radiation as their initial therapy. CONCLUSIONS Intermediate- and high-risk prostate cancers are associated with higher risk of other-cause mortality. This appears to be independent of treatment type and may not be solely explained by comorbidity status. Further studies controlling for comorbidity and treatment burden should be explored.
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Affiliation(s)
- Rehana Rasul
- Feinstein Institutes for Medical Research, Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States
| | - Anne Golden
- Feinstein Institutes for Medical Research, Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States
| | - Michael A Feuerstein
- Lenox Hill Hospital, Department of Urology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Associations among statins, preventive care, and prostate cancer mortality. Prostate Cancer Prostatic Dis 2020; 23:475-485. [PMID: 32029930 DOI: 10.1038/s41391-020-0207-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing evidence indicates an association between statins and reduced prostate cancer-specific mortality (PCSM). However, significant bias may exist in these studies. One particularly challenging bias to assess is the healthy user effect, which may be quantified by screening patterns. We aimed to evaluate the association between statin use, screening, and PCSM in a dataset with detailed longitudinal information. METHODS We used the Veterans Affairs Informatics and Computing Infrastructure to assemble a cohort of patients diagnosed with prostate cancer (PC) between 2000 and 2015. We collected patient-level demographic, comorbidity, and tumor data. We also assessed markers of preventive care utilization including cholesterol and prostate specific antigen (PSA) screening rates. Patients were considered prediagnosis statin users if they had at least one prescription one or more years prior to PC diagnosis. We evaluated PCSM using hierarchical Fine-Gray regression models and all-cause mortality (ACM) using a cox regression model. RESULTS The final cohort contained 68,432 men including 40,772 (59.6%) prediagnosis statin users and 27,660 (40.4%) nonusers. Prediagnosis statin users had higher screening rates than nonusers for cholesterol (90 vs. 69%, p < 0.001) and PSA (76 vs. 67%, p < 0.001). In the model which excluded screening, prediagnosis statin users had improved PCSM (SHR 0.90, 95% CI 0.84-0.97; p = 0.004) and ACM (HR 0.96, 95% CI 0.93-0.99; p = 0.02). However, after including cholesterol and PSA screening rates, prediagnosis statin users and nonusers showed no differences in PCSM (SHR 0.98, 95% CI 0.91-1.06; p = 0.59) or ACM (HR 1.02, 95% CI 0.98-1.05; p = 0.25). CONCLUSION We found that statin users tend to have more screening than nonusers. When we considered screening utilization, we observed no relationship between statin use before a prostate cancer diagnosis and prostate cancer mortality.
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Sarkar RR, Parsons JK, Bryant AK, Ryan ST, Kader AK, McKay RR, D'Amico AV, Nguyen PL, Hulley BJ, Einck JP, Mundt AJ, Kane CJ, Murphy JD, Rose BS. Association of Treatment With 5α-Reductase Inhibitors With Time to Diagnosis and Mortality in Prostate Cancer. JAMA Intern Med 2019; 179:812-819. [PMID: 31058923 PMCID: PMC6503564 DOI: 10.1001/jamainternmed.2019.0280] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE 5α-Reductase inhibitors (5-ARIs), commonly used to treat benign prostatic hyperplasia, reduce serum prostate-specific antigen (PSA) concentrations by 50%. The association of 5-ARIs with detection of prostate cancer in a PSA-screened population remains unclear. OBJECTIVE To test the hypothesis that prediagnostic 5-ARI use is associated with a delayed diagnosis, more advanced disease at diagnosis, and higher risk of prostate cancer-specific mortality and all-cause mortality than use of other or no PSA-decreasing drugs. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study linked the Veterans Affairs Informatics and Computing Infrastructure with the National Death Index to obtain patient records for 80 875 men with American Joint Committee on Cancer stage I-IV prostate cancer diagnosed from January 1, 2001, to December 31, 2015. Patients were followed up until death or December 31, 2017. Data analysis was performed from March 2018 to May 2018. EXPOSURES Prediagnostic 5-ARI use. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer-specific mortality (PCSM). Secondary outcomes included time from first elevated PSA (defined as PSA≥4 ng/mL) to diagnostic prostate biopsy, cancer grade and stage at time of diagnosis, and all-cause mortality (ACM). Prostate-specific antigen levels for 5-ARI users were adjusted by doubling the value, consistent with previous clinical trials. RESULTS Median (interquartile range [IQR]) age at diagnosis was 66 (61-72) years; median [IQR] follow-up was 5.90 (3.50-8.80) years. Median time from first adjusted elevated PSA to diagnosis was significantly greater for 5-ARI users than 5-ARI nonusers (3.60 [95% CI, 1.79-6.09] years vs 1.40 [95% CI, 0.38-3.27] years; P < .001) among patients with known prostate biopsy date. Median adjusted PSA at time of biopsy was significantly higher for 5-ARI users than 5-ARI non-users (13.5 ng/mL vs 6.4 ng/mL; P < .001). Patients treated with 5-ARI were more likely to have Gleason grade 8 or higher (25.2% vs 17.0%; P < .001), clinical stage T3 or higher (4.7% vs 2.9%; P < .001), node-positive (3.0% vs 1.7%; P < .001), and metastatic (6.7% vs 2.9%; P < .001) disease than 5-ARI nonusers. In a multivariable regression, patients who took 5-ARI had higher prostate cancer-specific (subdistribution hazard ratio [SHR], 1.39; 95% CI, 1.27-1.52; P < .001) and all-cause (HR, 1.10; 95% CI, 1.05-1.15; P < .001) mortality. CONCLUSIONS AND RELEVANCE Results of this study demonstrate that prediagnostic use of 5-ARIs was associated with delayed diagnosis and worse cancer-specific outcomes in men with prostate cancer. These data highlight a continued need to raise awareness of 5-ARI-induced PSA suppression, establish clear guidelines for early prostate cancer detection, and motivate systems-based practices to facilitate optimal care for men who use 5-ARIs.
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Affiliation(s)
- Reith R Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - J Kellog Parsons
- Department of Urology, University of California San Diego, La Jolla
| | - Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Stephen T Ryan
- Department of Urology, University of California San Diego, La Jolla
| | - Andrew K Kader
- Department of Urology, University of California San Diego, La Jolla
| | - Rana R McKay
- Department of Internal Medicine, Division of Hematology-Oncology, University of California San Diego, La Jolla
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin J Hulley
- Department of Medicine, Veterans Affairs San Diego Health System, La Jolla.,Department of Internal Medicine, University of California San Diego, La Jolla
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | | | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
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Tan KS. Misclassification of the actual causes of death and its impact on analysis: A case study in non-small cell lung cancer. Lung Cancer 2019; 134:16-24. [PMID: 31319976 DOI: 10.1016/j.lungcan.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cumulative incidence of lung cancer deaths (LC-CID) is an important metric to understand cancer prognosis and to determine treatment options. However, credible estimates of LC-CID rely on accurate cause-of-death coding in death certificates. Results from lung cancer screening trials estimated 15% under-reporting and 1% over-reporting of lung cancer deaths due to misclassification. This study investigated the impact of cause-of-death misclassification on the estimation of LC-CID. MATERIALS AND METHODS Patients with stage I/II non-small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results registry were included. LC-CID was estimated using the competing-risk approach in two ways: (1) reporting observed estimates that ignore potential cause-of-death misclassification and (2) correcting for plausible misclassification rates reported in the literature (15% under-reporting and 1% over-reporting). Bias was quantified as the difference between observed and corrected 10-year LC-CIDs: positive values indicated that observed LC-CID overestimated true LC-CID, whereas negative values indicated the opposite. RESULTS Among 66,179 patients, the impact of over-reporting on 10-year LC-CID was negligible across all age groups. In contrast, under-reporting resulted in substantial underestimation of 10-year LC-CID. The biases increased as age increased due to higher LC-CIDs: 10-year LC-CIDs among stage I patients 18-44, 45-59, 60-74 and ≥75 years were 25%, 32%, 41%, and 50%, respectively, and the corresponding biases given the plausible misclassification rates were -4.4%, -5.6%, -7.1%, and -8.6%. Because the observed LC-CIDs among patients with stage II disease were higher than those with stage I disease, the biases were greater among stage II patients, up to -12.5% in the oldest age group. CONCLUSIONS In lung cancer, LC-CID may be severely underestimated due to under-reporting of lung cancer deaths, particularly among older patients or those with late-stage disease. Future studies that involve such subpopulations should present the corrected LC-CIDs based on plausible misclassification rates alongside the observed LC-CIDs.
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Affiliation(s)
- Kay See Tan
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2(nd) Floor, New York, NY, 10017, United States.
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Assi T, Bakouny Z, Labaki C, El Rassy E, Khazzaka A, Jabbour R, Haddad FG, Tohme A, El Karak F, Ghosn M, Kattan J. Causes of death in older patients with cancer: Experience of a tertiary care center in Lebanon. J Geriatr Oncol 2019; 10:365-367. [DOI: 10.1016/j.jgo.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/09/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022]
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Gansler T, Shah R, Wang Y, Stevens VL, Yang B, Newton CC, Gapstur SM, Jacobs EJ. Smoking and Prostate Cancer–Specific Mortality after Diagnosis in a Large Prospective Cohort. Cancer Epidemiol Biomarkers Prev 2018; 27:665-672. [DOI: 10.1158/1055-9965.epi-17-0890] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/29/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
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La Vecchia C, Bruzzi P, Decarli A, Gaboardi F, Boyle P. An Estimate of Prostate Cancer Prevalence in Italy. TUMORI JOURNAL 2018; 88:367-9. [PMID: 12487552 DOI: 10.1177/030089160208800503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estimates of the total number of men with a previous diagnosis of prostate cancer in Italy range from 55,000 to 135,000. This wide range of variation is largely due to uncertainties on the number of protein-specific antigen-detected, asymptomatic cases. The number of clinically detected cases, including cases with advanced disease, is less subject to uncertainty, with reasonable estimates ranging from 45,000 to 60,000.
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Vatandoust S, Kichenadasse G, O'Callaghan M, Vincent AD, Kopsaftis T, Walsh S, Borg M, Karapetis CS, Moretti K. Localised prostate cancer in elderly men aged 80-89 years, findings from a population-based registry. BJU Int 2018; 121 Suppl 3:48-54. [PMID: 29603585 DOI: 10.1111/bju.14228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sina Vatandoust
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide SA Australia
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Department of Medical Oncology; Flinders Medical Centre; Bedford Park SA Australia
| | - Ganessan Kichenadasse
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide SA Australia
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Department of Medical Oncology; Flinders Medical Centre; Bedford Park SA Australia
| | - Michael O'Callaghan
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide SA Australia
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Urology Unit; Repatriation General Hospital, Daw Park; Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health; Adelaide SA Australia
- University of Adelaide; Adelaide SA Australia
| | - Andrew D. Vincent
- Freemasons Foundation Centre for Men's Health; Adelaide SA Australia
- University of Adelaide; Adelaide SA Australia
| | - Tina Kopsaftis
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Urology Unit; Repatriation General Hospital, Daw Park; Adelaide SA Australia
| | - Scott Walsh
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Urology Unit; Repatriation General Hospital, Daw Park; Adelaide SA Australia
| | - Martin Borg
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- University of Adelaide; Adelaide SA Australia
- Adelaide Radiotherapy Centre; Adelaide SA Australia
| | - Christos S. Karapetis
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide SA Australia
- Department of Medical Oncology; Flinders Medical Centre; Bedford Park SA Australia
| | - Kim Moretti
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide SA Australia
- The South Australian Prostate Cancer Clinical Outcomes Collaborative; Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health; Adelaide SA Australia
- University of Adelaide; Adelaide SA Australia
- University of South Australia; Adelaide SA Australia
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Schaumberg DA, McDonald L, Shah S, Stokes M, Nordstrom BL, Ramagopalan SV. Evaluation of comparative effectiveness research: a practical tool. J Comp Eff Res 2018; 7:503-515. [PMID: 29463115 DOI: 10.2217/cer-2018-0007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Comparative effectiveness research (CER) guidelines have been developed to direct the field toward the most rigorous study methodologies. A challenge, however, is how to ensure the best evidence is generated, and how to translate methodologically complex or nuanced CER findings into usable medical evidence. To reach that goal, it is important that both researchers and end users of CER output become knowledgeable about the elements that impact the quality and interpretability of CER. This paper distilled guidance on CER into a practical tool to assist both researchers and nonexperts with the critical review and interpretation of CER, with a focus on issues particularly relevant to CER in oncology.
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Affiliation(s)
| | - Laura McDonald
- Center for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UB8 1DH, UK
| | - Surbhi Shah
- Real-World Evidence, Evidera, Waltham, MA 02451, USA
| | - Michael Stokes
- Real-World Evidence, Evidera, St-Laurent, Quebec, H4T1V6, Canada
| | | | - Sreeram V Ramagopalan
- Center for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UB8 1DH, UK
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Mehta HB, Sura SD, Adhikari D, Andersen CR, Williams SB, Senagore AJ, Kuo YF, Goodwin JS. Adapting the Elixhauser comorbidity index for cancer patients. Cancer 2018; 124:2018-2025. [PMID: 29390174 DOI: 10.1002/cncr.31269] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study was designed to adapt the Elixhauser comorbidity index for 4 cancer-specific populations (breast, prostate, lung, and colorectal) and compare 3 versions of the Elixhauser comorbidity score (individual comorbidities, summary comorbidity score, and cancer-specific summary comorbidity score) with 3 versions of the Charlson comorbidity score for predicting 2-year survival with 4 types of cancer. METHODS This cohort study used Texas Cancer Registry-linked Medicare data from 2005 to 2011 for older patients diagnosed with breast (n = 19,082), prostate (n = 23,044), lung (n = 26,047), or colorectal cancer (n = 16,693). For each cancer cohort, the data were split into training and validation cohorts. In the training cohort, competing risk regression was used to model the association of Elixhauser comorbidities with 2-year noncancer mortality, and cancer-specific weights were derived for each comorbidity. In the validation cohort, competing risk regression was used to compare 3 versions of the Elixhauser comorbidity score with 3 versions of the Charlson comorbidity score. Model performance was evaluated with c statistics. RESULTS The 2-year noncancer mortality rates were 14.5% (lung cancer), 11.5% (colorectal cancer), 5.7% (breast cancer), and 4.1% (prostate cancer). Cancer-specific Elixhauser comorbidity scores (c = 0.773 for breast cancer, c = 0.772 for prostate cancer, c = 0.579 for lung cancer, and c = 0.680 for colorectal cancer) performed slightly better than cancer-specific Charlson comorbidity scores (ie, the National Cancer Institute combined index; c = 0.762 for breast cancer, c = 0.767 for prostate cancer, c = 0.578 for lung cancer, and c = 0.674 for colorectal cancer). Individual Elixhauser comorbidities performed best (c = 0.779 for breast cancer, c = 0.783 for prostate cancer, c = 0.587 for lung cancer, and c = 0.687 for colorectal cancer). CONCLUSIONS The cancer-specific Elixhauser comorbidity score performed as well as or slightly better than the cancer-specific Charlson comorbidity score in predicting 2-year survival. If the sample size permits, using individual Elixhauser comorbidities may be the best way to control for confounding in cancer outcomes research. Cancer 2018;124:2018-25. © 2018 American Cancer Society.
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Affiliation(s)
- Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Sneha D Sura
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas
| | - Deepak Adhikari
- School of Public Health, Brown University, Providence, Rhode Island
| | - Clark R Andersen
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Anthony J Senagore
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - James S Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Mari A, Abufaraj M, Foerster B, Özsoy M, Briganti A, Rouprêt M, Karakiewicz PI, Mathieu R, D'Andrea D, Chade DC, Shariat SF. Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer. Clin Genitourin Cancer 2017; 16:e619-e627. [PMID: 29239845 DOI: 10.1016/j.clgc.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/22/2017] [Accepted: 10/30/2017] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The purpose of the present study was to investigate the association of smoking with biochemical recurrence (BCR) and metastasis in radiation-recurrent prostate cancer (PCa) patients undergoing salvage radical prostatectomy (SRP). PATIENTS AND METHODS A total of 214 patients treated with SRP for radiation-recurrent PCa in 5 tertiary referral centers were included from January 2007 to December 2015. Kaplan-Meier analyses were used to assess the time to BCR and metastasis. Pre- and postoperative multivariable Cox proportional hazard regression models were fitted. RESULTS Overall, 120 (56.1%), 49 (22.9%), and 45 (21%) patients were never, former, and current smokers, respectively. Low-, medium-, and high-cumulative smoking exposure was registered in 59.8%, 16.4%, and 23.8% of cases, respectively. Patients with high cumulative smoking exposure had a significantly greater rate of a pathologic Gleason score of ≥ 8 (P = .01) and extracapsular extension (P = .004). Smoking status, cumulative smoking exposure, intensity, and duration were significantly associated with BCR-free survival (P < .001 for all). Smoking status, cumulative smoking exposure, and smoking intensity were significantly associated with metastasis-free survival (P = .03 for all). High cumulative smoking exposure was independently associated with BCR in both pre- (hazard ratio, 2.23; P = .001) and postoperative (hazard ratio, 1.64; P = .04) multivariable models adjusted for the effects of established clinicopathologic features. Smoking cessation did not affect either BCR- or metastasis-free survival (P = .56 and P = .40, respectively). CONCLUSION High cumulative smoking exposure was associated with the biologic and clinical aggressiveness of PCa in patients treated with SRP for radiation-recurrent disease. Smoking is a modifiable risk factor that detrimentally affected the outcomes, even in patients with advanced PCa.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mehmet Özsoy
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Morgan Rouprêt
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | | | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daher C Chade
- Department of Urology, University of São Paulo Medical School and Institute of Cancer, São Paulo, Brazil
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Wallis CJD, Glaser A, Hu JC, Huland H, Lawrentschuk N, Moon D, Murphy DG, Nguyen PL, Resnick MJ, Nam RK. Survival and Complications Following Surgery and Radiation for Localized Prostate Cancer: An International Collaborative Review. Eur Urol 2017; 73:11-20. [PMID: 28610779 DOI: 10.1016/j.eururo.2017.05.055] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/30/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evaluation of treatment options for localized prostate cancer (PCa) remains among the highest priorities for comparative effectiveness research. Surgery and radiotherapy (RT) are the two interventions most commonly used. OBJECTIVE To provide a critical narrative review of evidence of the comparative effectiveness and harms of surgery and RT in the treatment of localized PCa. EVIDENCE ACQUISITION A collaborative critical narrative review of the literature was conducted. EVIDENCE SYNTHESIS Evidence to clearly guide treatment choice in PCa remains insufficient. Randomized trials are underpowered for clinically meaningful endpoints and have demonstrated no difference in overall or PCa-specific survival. Observational studies have consistently demonstrated an absolute survival benefit for men treated with radical prostatectomy, but are limited by selection bias and residual confounding errors. Surgery and RT are associated with comparable health-related quality of life following treatment in three randomized trials. Randomized data regarding urinary, erectile, and bowel function show few long-term (>5 yr) differences, although short-term continence and erectile function were worse following surgery and short-term urinary bother and bowel function were worse following RT. There has been recent recognition of other complications that may significantly affect the life trajectory of those undergoing PCa treatment. Of these, hospitalization, the need for urologic, rectoanal, and other major surgical procedures, and secondary cancers are more common among men treated with RT. Androgen deprivation therapy, frequently co-administered with RT, may additionally contribute to treatment-related morbidity. Technological innovations in surgery and RT have shown inconsistent oncologic and functional benefits. CONCLUSIONS Owing to underpowered randomized control studies and the selection biases inherent in observational studies, the question of which treatment provides better PCa control cannot be definitively answered now or in the near future. Complications following PCa treatment are relatively common regardless of treatment approach. These include the commonly identified issues of urinary incontinence and erectile dysfunction, and others including hospitalization and invasive procedures to manage complications and secondary malignancies. Population-based outcome studies, rather than clinical trial data, will be necessary for a comprehensive understanding of the relative benefits and risks of each therapeutic approach. PATIENT SUMMARY Surgery and radiotherapy are the most common interventions for men diagnosed with prostate cancer. Comparisons of survival after these treatments are limited by various flaws in the relevant studies. Complications are common regardless of the treatment approach.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Central Clinical School, Monash University, Clayton, Australia; The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, TN, USA
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.
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18
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Sensitivity of Medicare Claims to Identify Cancer Recurrence in Elderly Colorectal and Breast Cancer Patients. Med Care 2017; 54:e47-54. [PMID: 24374419 DOI: 10.1097/mlr.0000000000000058] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Researchers are increasingly interested in using observational data to evaluate cancer outcomes following treatment, including cancer recurrence and disease-free survival. Because population-based cancer registries do not collect recurrence data, recurrence is often imputed from health claims, primarily by identifying later cancer treatments after initial treatment. The validity of this approach has not been established. RESEARCH DESIGN We used the linked Surveillance, Epidemiology, and End Results-Medicare data to assess the sensitivity of Medicare claims for cancer recurrence in patients very likely to have had a recurrence. We selected newly diagnosed stage II/III colorectal (n=6910) and female breast cancer (n=3826) patients during 1994-2003 who received initial cancer surgery, had a treatment break, and then died from cancer in 1994-2008. We reviewed all claims from the treatment break until death for indicators of recurrence. We focused on additional cancer treatment (surgery, chemotherapy, radiation therapy) as the primary indicator, and used multivariate logistic regression analysis to evaluate patient factors associated with additional treatment. We also assessed metastasis diagnoses and end-of-life care as recurrence indicators. RESULTS Additional treatment was the first indicator of recurrence for 38.8% of colorectal patients and 35.2% of breast cancer patients. Patients aged 70 and older were less likely to have additional treatment (P < 0.05), in adjusted analyses. Over 20% of patients either had no recurrence indicator before death or had end-of-life care as their first indicator. CONCLUSIONS Identifying recurrence through additional cancer treatment in Medicare claims will miss a large percentage of patients with recurrences; particularly those who are older.
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Koroukian SM, Schiltz NK, Warner DF, Given CW, Schluchter M, Owusu C, Berger NA. Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer. J Geriatr Oncol 2017; 8:117-124. [PMID: 28029586 PMCID: PMC5373955 DOI: 10.1016/j.jgo.2016.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/12/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care. METHODS From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders. RESULTS While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others. CONCLUSIONS To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio, United States.
| | - Nicholas K Schiltz
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio, United States
| | - David F Warner
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Charles W Given
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Mark Schluchter
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Medicine, Division of Hematology/Oncology, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Nathan A Berger
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Medicine, Division of Hematology/Oncology, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
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Walter SD, de Koning HJ, Hugosson J, Talala K, Roobol MJ, Carlsson S, Zappa M, Nelen V, Kwiatkowski M, Páez Á, Moss S, Auvinen A. Impact of cause of death adjudication on the results of the European prostate cancer screening trial. Br J Cancer 2017; 116:141-148. [PMID: 27855442 PMCID: PMC5220145 DOI: 10.1038/bjc.2016.378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The European Randomised Study of Prostate Cancer Screening has shown a 21% relative reduction in prostate cancer mortality at 13 years. The causes of death can be misattributed, particularly in elderly men with multiple comorbidities, and therefore accurate assessment of the underlying cause of death is crucial for valid results. To address potential unreliability of end-point assessment, and its possible impact on mortality results, we analysed the study outcome adjudication data in six countries. METHODS Latent class statistical models were formulated to compare the accuracy of individual adjudicators, and to assess whether accuracy differed between the trial arms. We used the model to assess whether correcting for adjudication inaccuracies might modify the study results. RESULTS There was some heterogeneity in adjudication accuracy of causes of death, but no consistent differential accuracy by trial arm. Correcting the estimated screening effect for misclassification did not alter the estimated mortality effect of screening. CONCLUSIONS Our findings were consistent with earlier reports on the European screening trial. Observer variation, while demonstrably present, is unlikely to have materially biased the main study results. A bias in assigning causes of death that might have explained the mortality reduction by screening can be effectively ruled out.
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Affiliation(s)
- Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, CRL 233, 1280 Main Street, Hamilton, Ontario, Canada L8S 4K1
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
| | - Kirsi Talala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, FI-00130 Helsinki, Finland
| | - Monique J Roobol
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Sigrid Carlsson
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marco Zappa
- ISPO–Cancer Research and Prevention Institute, Clinical and Descriptive Epidemiology Unit, Via delle Oblate 2, 50141 Florence, Italy
| | - Vera Nelen
- Provinciaal Instituut Voor Hygiëne (Labo's), Kronenburgstraat 45, 2000 Antwerpen, Belgium
| | - Maciej Kwiatkowski
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Álvaro Páez
- Department of Urology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 FUENLABRADA (Madrid), Spain
| | - Sue Moss
- Wolfson Institute, St Mary University, Charterhouse Square, London EC1M 6BQ, UK
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
| | - the ERSPC Cause of Death Committees
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, CRL 233, 1280 Main Street, Hamilton, Ontario, Canada L8S 4K1
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, FI-00130 Helsinki, Finland
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- ISPO–Cancer Research and Prevention Institute, Clinical and Descriptive Epidemiology Unit, Via delle Oblate 2, 50141 Florence, Italy
- Provinciaal Instituut Voor Hygiëne (Labo's), Kronenburgstraat 45, 2000 Antwerpen, Belgium
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
- Department of Urology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 FUENLABRADA (Madrid), Spain
- Wolfson Institute, St Mary University, Charterhouse Square, London EC1M 6BQ, UK
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
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Boehm K, Dell’Oglio P, Tian Z, Capitanio U, Chun FKH, Tilki D, Haferkamp A, Saad F, Montorsi F, Graefen M, Karakiewicz PI. Comorbidity and age cannot explain variation in life expectancy associated with treatment of non-metastatic prostate cancer. World J Urol 2016; 35:1031-1036. [DOI: 10.1007/s00345-016-1963-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
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Racial Disparities in Prostate Cancer Mortality in the 50 Largest US Cities. Cancer Epidemiol 2016; 44:125-131. [PMID: 27566470 DOI: 10.1016/j.canep.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/27/2016] [Accepted: 07/31/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION This paper presents race-specific prostate cancer mortality rates and the corresponding disparities for the largest cities in the US over two decades. METHODS The 50 largest cities in the US were the units of analysis. Data from two 5-year periods were analyzed: 1990-1994 and 2005-2009. Numerator data were abstracted from national death files where the cause was malignant neoplasm of prostate (prostate cancer) (ICD9=185 and ICD10=C61). Population-based denominators were obtained from US Census data. To measure the racial disparity, we calculated non-Hispanic Black: non-Hispanic White rate ratios (RRs), rate differences (RDs), and corresponding confidence intervals for each 5-year period. We also calculated correlation and unadjusted regression coefficients for 11 city-level variables, such as segregation and median income, and the RDs. RESULTS At the final time point (2005-2009), the US and all 41 cities included in the analyses had a RR greater than 1 (indicating that the Black rate was higher than the White rate) (range=1.13 in Minneapolis to 3.24 in Los Angeles), 37 of them statistically significantly so. The US and 26 of the 41 cities saw an increase in the Black:White RR between the time points. The level of disparity within a city was associated with the degree of Black segregation. CONCLUSION This analysis revealed large disparities in Black:White prostate cancer mortality in the US and many of its largest cities over the past two decades. The data show considerable variation in the degree of disparity across cities, even among cities within the same state. This type of specific city-level data can be used to motivate public health professionals, government officials, cancer control agencies, and community-based organizations in cities with large or increasing disparities to demand more resources, focus research efforts, and implement effective policy and programmatic changes in order to combat this highly prevalent condition.
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Alanee S, Ganai S, Gupta P, Holland B, Dynda D, Slaton J. Disparities in long-term radiographic follow-up after cystectomy for bladder cancer: Analysis of the SEER-Medicare database. Urol Ann 2016; 8:178-83. [PMID: 27141188 PMCID: PMC4839235 DOI: 10.4103/0974-7796.164852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: It is uncertain whether there are disparities related to receiving long-term radiographic follow-up after cystectomy performed for bladder cancer, and whether intensive follow-up influences survival. Materials and Methods: We analyzed 2080 patients treated with cystectomy between 1992 and 2004 isolated from the SEER-Medicare database. The number of abdominal computerized tomography scans performed in patients surviving 2 years after surgery was used as an indicator of long-term radiographic follow-up to exclude patients with early failures. Results: Patients were mainly males (83.18%), had a mean age at diagnosis of 73.4 ± 6.6 (standard deviation) years, and mean survival of 4.6 ± 3.2 years. Multivariate analysis showed age >70 (odds ratio [OR]: 0.796, 95% confidence interval [CI]: 0.651–0.974), African American race (OR: 0.180, 95% CI: 0.081–0.279), and Charlson comorbidity score >2 (OR: 0.694, 95% CI: 0.505–0.954) to be associated with lower odds of long-term radiographic follow-up. Higher disease stage (Stage T4N1) (OR: 1.873, 95% CI: 1.491–2.353), higher quartile for education (OR: 5.203, 95% CI: 1.072–9.350) and higher quartile for income (OR: 6.940, 95% CI: 1.444–12.436) were associated with increased odds of long-term radiographic follow-up. Interestingly, more follow-up with imaging after cystectomy did not improve cancer-specific or overall survival in these patients. Conclusion: There are significant age, race, and socioeconomic disparities in long-term radiographic follow-up after radical cystectomy. However, more radiographic follow-up may not be associated with better survival.
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Affiliation(s)
- Shaheen Alanee
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sabha Ganai
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Priyanka Gupta
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bradley Holland
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Danuta Dynda
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Joel Slaton
- Department of Urology, University of Oklahoma, School of Medicine, Oklahoma City, Oklahoma, USA
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Dell'Oglio P, Suardi N, Boorjian SA, Fossati N, Gandaglia G, Tian Z, Moschini M, Capitanio U, Karakiewicz PI, Montorsi F, Karnes RJ, Briganti A. Predicting survival of men with recurrent prostate cancer after radical prostatectomy. Eur J Cancer 2016; 54:27-34. [DOI: 10.1016/j.ejca.2015.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/14/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
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Zhou CK, Levine PH, Cleary SD, Hoffman HJ, Graubard BI, Cook MB. Male Pattern Baldness in Relation to Prostate Cancer-Specific Mortality: A Prospective Analysis in the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 2016; 183:210-7. [PMID: 26764224 PMCID: PMC4724092 DOI: 10.1093/aje/kwv190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023] Open
Abstract
We used male pattern baldness as a proxy for long-term androgen exposure and investigated the association of dermatologist-assessed hair loss with prostate cancer-specific mortality in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. From the baseline survey (1971-1974), we included 4,316 men who were 25-74 years of age and had no prior cancer diagnosis. We estimated hazard ratios and used Cox proportional hazards regressions with age as the time metric and baseline hazard stratified by baseline age. A hybrid framework was used to account for stratification and clustering of the sample design, with adjustment for the variables used to calculate sample weights. During follow-up (median, 21 years), 3,284 deaths occurred; prostate cancer was the underlying cause of 107. In multivariable models, compared with no balding, any baldness was associated with a 56% higher risk of fatal prostate cancer (hazard ratio = 1.56; 95% confidence interval: 1.02, 2.37), and moderate balding specifically was associated with an 83% higher risk (hazard ratio = 1.83; 95% confidence interval: 1.15, 2.92). Conversely, patterned hair loss was not statistically significantly associated with all-cause mortality. Our analysis suggests that patterned hair loss is associated with a higher risk of fatal prostate cancer and supports the hypothesis of overlapping pathophysiological mechanisms.
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Affiliation(s)
| | | | | | | | | | - Michael B. Cook
- Correspondence to Dr. Michael B. Cook, Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room 7-E106, MSC 9774, Bethesda, MD 20892-9774 (e-mail: )
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Dell'Oglio P, Karnes RJ, Joniau S, Spahn M, Gontero P, Tosco L, Fossati N, Kneitz B, Chlosta P, Graefen M, Marchioro G, Bianchi M, Sanchez-Salas R, Karakiewicz PI, Poppel HV, Montorsi F, Briganti A. Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer. Urol Oncol 2015; 34:234.e13-9. [PMID: 26706120 DOI: 10.1016/j.urolonc.2015.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. MATERIALS AND METHODS Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. RESULTS The 10-, 15- and 20-year CSM and OCM rates were 11.6% and 5.5% vs. 15.5% and 13.5% vs. 18.4% and 19.3%, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4% and 2.7% vs. 4.6% and 9.6% vs. 4.2% and 8.2%, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). CONCLUSIONS Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.
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Affiliation(s)
- Paolo Dell'Oglio
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Martin Spahn
- Department of Urology, University of Bern, Bern, Switzerland
| | - Paolo Gontero
- Department of Urology, University of Turin, Torino, Italy
| | - Lorenzo Tosco
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Krakow, Poland
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Marco Bianchi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Lu-Yao GL, Albertsen PC, Moore DF, Lin Y, DiPaola RS, Yao SL. Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer. Eur Urol 2015; 68:805-11. [PMID: 25800944 PMCID: PMC4575827 DOI: 10.1016/j.eururo.2015.03.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND To understand the threat posed by localized prostate cancer and the potential impact of surgery or radiation, patients and healthcare providers require information on long-term outcomes following conservative management. OBJECTIVE To describe 15-yr survival outcomes and cancer therapy utilization among men 65 years and older managed conservatively for newly diagnosed localized prostate cancer. DESIGN, SETTINGS, AND PARTICIPANTS This is a population-based cohort study with participants living in predefined geographic areas covered by the Surveillance, Epidemiology, and End Results program. The study includes 31 137 Medicare patients aged ≥65 yr diagnosed with localized prostate cancer in 1992-2009 who initially received conservative management (no surgery, radiotherapy, cryotherapy, or androgen deprivation therapy [ADT]). All patients were followed until death or December 31, 2009 (for prostate cancer-specific mortality [PCSM]) and December 31, 2011 (for overall mortality). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing-risk analyses were used to examine PCSM, overall mortality, and utilization of cancer therapies. RESULTS AND LIMITATIONS The 15-yr risk of PCSM for men aged 65-74 yr diagnosed with screening-detected prostate cancer was 5.7% (95% confidence interval [CI] 3.7-8.0%) for T1c Gleason 5-7 and 22% (95% CI 16-35%) for Gleason 8-10 disease. After 15 yr of follow-up, 24% (95% CI 21-27%) of men aged 65-74 yr with screening-detected Gleason 5-7 cancer received ADT. The corresponding result for men with Gleason 8-10 cancer was 38% (95% CI 32-44%). The major study limitations are the lack of data for men aged <65 yr and detailed clinical information associated with secondary cancer therapy. CONCLUSIONS The 15-yr outcomes following conservative management of newly diagnosed Gleason 5-7 prostate cancer among men aged ≥65 yr are excellent. Men with Gleason 8-10 disease managed conservatively face a significant risk of PCSM. PATIENT SUMMARY We examined the long-term survival outcomes for a large group of patients diagnosed with localized prostate cancer who did not have surgery, radiotherapy, cryotherapy, or androgen deprivation therapy in the first 6 mo after cancer diagnosis. We found that the 15-yr disease-specific survival is excellent for men diagnosed with Gleason 5-7 disease. The data support conservative management as a reasonable choice for elderly patients with low-grade localized prostate cancer.
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Affiliation(s)
- Grace L Lu-Yao
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| | - Peter C Albertsen
- Department of Surgery (Urology), University of Connecticut, Farmington, CT, USA
| | - Dirk F Moore
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Robert S DiPaola
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Siu-Long Yao
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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Hoffman RM, Koyama T, Albertsen PC, Barry MJ, Daskivich TJ, Goodman M, Hamilton AS, Stanford JL, Stroup AM, Potosky AL, Penson DF. Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study. J Gen Intern Med 2015; 30:924-34. [PMID: 25678374 PMCID: PMC4471031 DOI: 10.1007/s11606-014-3171-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Guidelines recommend against treating localized prostate cancer (PCa) in men with a greater than 10-year life expectancy. However, physicians have difficulty accurately estimating life expectancy. OBJECTIVE We used data from a population-based observational study to develop a nomogram to estimate long-term other-cause mortality based on self-reported health status (SRHS), race/ethnicity, and age at diagnosis. DESIGN This was an observational study. SUBJECTS Men diagnosed with localized PCa from October 1994 through October 1995 participated in the study. MAIN MEASURES Initial measures obtained 6 months after diagnosis included sociodemographic and tumor characteristics, treatment, and a single item on the SRHS, with response options ranging from excellent to poor. We used Surveillance, Epidemiology, and End-Results program data to determine date and cause of death through December 2010. We estimated other-cause mortality with proportional hazards survival analyses, accounting for competing risks. KEY RESULTS We evaluated 2,695 men, of whom 74% underwent aggressive therapy (surgery or radiotherapy). At the initial survey, 18% reported excellent (E), 36% very good (VG), 31% good (G), and 15% fair/poor (F/P) health. Healthier men were younger, and more likely to be white, better educated, and to undergo surgery. At follow-up, 44% of the cohort had died; 78% of deaths were from causes other than PCa. SRHS predicted other-cause mortality; for men reporting E, VG, G, F/P health, the cumulative incidences of other-cause mortality were 20%, 29%, 40%, and 53%, respectively, p < 0.001. Compared to a reference of excellent SRHS, multivariable hazard ratios (95% CI) for other-cause mortality for men reporting VG, G, and F/P health were 1.22 (0.97-1.54), 1.73 (1.38-2.17), and 2.71 (2.11-3.48), respectively. CONCLUSIONS Responses to a one-item SRHS measure were strongly associated with other-cause mortality 15 years after PCa diagnosis. Men reporting fair/poor health had substantial risks for other-cause mortality, suggesting limited benefit for undergoing aggressive treatment. SRHS can be considered in supporting informed decision-making about PCa treatment.
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Affiliation(s)
- Richard M Hoffman
- University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA,
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Valdivieso R, Boehm K, Meskawi M, Larcher A, Tian Z, Parent ME, Wong P, Graefen M, Montorsi F, Sun M, Saad F, Karakiewicz PI. Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians. World J Urol 2015; 33:1985-91. [PMID: 25854524 DOI: 10.1007/s00345-015-1553-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/31/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa). OBJECTIVE To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy. PATIENTS AND METHODS Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used. RESULTS In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years. CONCLUSIONS Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.
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Affiliation(s)
- Roger Valdivieso
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
- Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Katharina Boehm
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Malek Meskawi
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
- Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alessandro Larcher
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
- Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
| | - Marie-Elise Parent
- INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, QC, Canada
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Philip Wong
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, QC, Canada
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
| | - Fred Saad
- Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada
- Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
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Prasad SM, Hu JC. Reply to P. Stattin. J Clin Oncol 2015; 33:1087. [PMID: 25646193 DOI: 10.1200/jco.2014.59.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jim C Hu
- University of California Los Angeles, Los Angeles, CA
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Feletto E, Bang A, Cole-Clark D, Chalasani V, Rasiah K, Smith DP. An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? World J Urol 2015; 33:1677-87. [PMID: 25698456 PMCID: PMC4617845 DOI: 10.1007/s00345-015-1514-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/23/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using US mortality rates. METHODS Analysis of age-standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developed countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using US mortality rates, were calculated and compared with observed deaths in Australia (1994-2010). RESULTS In all four countries, incidence rates initially peaked between 1992 and 1994, but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8 % (1998-2008). Mortality rates in the USA (APC: -2.9 %; 2004-2010), Canada (APC: -2.9 %; 2006-2011) and England (APC: -2.6 %; 2003-2008) decreased at a faster rate compared with Australia (APC: -1.7 %; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared with US rates over 17 preceding years. CONCLUSIONS Prostate cancer incidence rates are likely heavily influenced by prostate-specific antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.
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Affiliation(s)
- E Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - A Bang
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - D Cole-Clark
- Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - V Chalasani
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Discipline of Surgery, University of Sydney, Camperdown, NSW, Australia. .,Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - K Rasiah
- Northern Sydney Local Health District, St Leonards, NSW, Australia. .,Kinghorn Cancer Centre, Garvan Institute of Medical Research, St Leonards, NSW, Australia.
| | - D P Smith
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia. .,Griffith Health Institute, Griffith University, Nathan, QLD, Australia.
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Bekelman JE, Mitra N, Handorf EA, Uzzo RG, Hahn SA, Polsky D, Armstrong K. Effectiveness of androgen-deprivation therapy and radiotherapy for older men with locally advanced prostate cancer. J Clin Oncol 2015; 33:716-22. [PMID: 25559808 DOI: 10.1200/jco.2014.57.2743] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We examined whether the survival advantage of androgen-deprivation therapy with radiotherapy (ADT plus RT) relative to ADT alone for men with locally advanced prostate cancer reported in two randomized trials holds in real-world clinical practice and extended the evidence to patients poorly represented in the trials. METHODS We conducted nonrandomized effectiveness studies of ADT plus RT versus ADT in three groups of patients diagnosed between 1995 and 2007 and observed through 2009 in the SEER-Medicare data set: (1) the randomized clinical trial (RCT) cohort, which included men age 65 to 75 years and was most consistent with participants in the randomized trials; (2) the elderly cohort, which included men age > 75 years with locally advanced prostate cancer; and (3) the screen-detected cohort, which included men age ≥ 65 years with screen-detected high-risk prostate cancer. We evaluated cause-specific and all-cause mortality using propensity score, instrumental variable (IV), and sensitivity analyses. RESULTS In the RCT cohort, ADT plus RT was associated with reduced cause-specific and all-cause mortality relative to ADT alone (cause-specific propensity score-adjusted hazard ratio [HR], 0.43; 95% CI, 0.37 to 0.49; all-cause propensity score-adjusted HR, 0.63; 95% CI, 0.59 to 0.67). Effectiveness estimates for the RCT cohort were not significantly different from those from randomized trials (P > .1). In the elderly and screen-detected cohorts, ADT plus RT was also associated with reduced cause-specific and all-cause mortality. IV analyses produced estimates similar to those from propensity score-adjusted methods. CONCLUSION Older men with locally advanced or screen-detected high-risk prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival.
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Affiliation(s)
- Justin E Bekelman
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
| | - Nandita Mitra
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
| | - Elizabeth A Handorf
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
| | - Robert G Uzzo
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
| | - Stephen A Hahn
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
| | - Daniel Polsky
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
| | - Katrina Armstrong
- Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA
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Daskivich TJ, Fan KH, Koyama T, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Stanford JL, Stroup AM, Litwin MS, Penson DF. Prediction of long-term other-cause mortality in men with early-stage prostate cancer: results from the Prostate Cancer Outcomes Study. Urology 2015; 85:92-100. [PMID: 25261048 PMCID: PMC4275422 DOI: 10.1016/j.urology.2014.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To provide population-based estimates of other-cause mortality by age and comorbidity in men with prostate cancer for use at the point of care in shared decision making. MATERIALS AND METHODS We sampled 3183 men with nonmetastatic prostate cancer from the Prostate Cancer Outcomes Study, a US population-based prospective cohort. Survival analysis accounting for competing risks was used to provide predictions of other-cause and cancer-specific mortality by age, comorbidity, and tumor risk through 14 years of follow-up. RESULTS Older men had a higher absolute risk of other-cause mortality associated with comorbidity. For men with comorbidity counts of 0, 1, 2, and 3+, cumulative incidence of other-cause mortality at 14 years was 9%, 18%, 30%, and 35% for those younger than 60 years; 26%, 26%, and 48%, and 52% for those aged 60-70 years; and 49%, 57%, 66%, and 74% for those older than 70 years. Prostate cancer mortality at 14 years was 5%, 8%, and 23% for men with low-, intermediate-, and high-risk disease. Competing risk pictograms for each age/comorbidity/tumor-risk pair provide visual characterization of these risks over time. CONCLUSION Our survival tables may be used at the point of care as part of shared decision making. Men aged >60 years with multiple comorbidities have substantial risk of other-cause mortality within 15 years of diagnosis and should consider conservative management for low-risk disease, given its low incidence of cancer-specific mortality. Men with high-risk disease, regardless of age or comorbidity, are at greater risk for cancer mortality and may still be appropriate candidates for aggressive treatment.
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Affiliation(s)
- Timothy J Daskivich
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Kang-Hsien Fan
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Peter C Albertsen
- Division of Urology, Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT
| | | | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Richard M Hoffman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN; VA Tennessee Valley Geriatric Research, Education, and Clinical Centers, Nashville, TN
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Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Yao SL. Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer. JAMA Intern Med 2014; 174:1460-7. [PMID: 25023796 PMCID: PMC5499229 DOI: 10.1001/jamainternmed.2014.3028] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE One in 6 American men will be diagnosed as having prostate cancer during their lifetime. Although there are no data to support the use of primary androgen-deprivation therapy (ADT) for early-stage prostate cancer, primary ADT has been widely used for localized prostate cancer, especially among older patients. OBJECTIVE To determine the long-term survival impact of primary ADT in older men with localized (T1/T2) prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of 66,717 Medicare patients 66 years or older diagnosed from 1992 through 2009 who received no definitive local therapy within 180 days of prostate cancer diagnosis. The study was conducted in predefined US geographical areas covered by the Surveillance, Epidemiology, and End Results (SEER) Program. Instrumental variable analysis was used to assess the impact of primary ADT and control for potential biases associated with unmeasured confounding variables. The instrumental variable comprised combined health services areas with various usage rates of primary ADT. The analysis compared survival outcomes in the top tertile areas with those in the bottom tertile areas. MAIN OUTCOMES AND MEASURES Prostate cancer-specific survival and overall survival. RESULTS With a median follow-up of 110 months, primary ADT was not associated with improved 15-year overall or prostate cancer-specific survival following the diagnosis of localized prostate cancer. Among patients with moderately differentiated cancers, the 15-year overall survival was 20.0% in areas with high primary ADT use vs 20.8% in areas with low use (difference: 95% CI, -2.2% to 0.4%), and the 15-year prostate cancer survival was 90.6% in both high- and low-use areas (difference: 95% CI, -1.1% to 1.2%). Among patients with poorly differentiated cancers, the 15-year cancer-specific survival was 78.6% in high-use areas vs 78.5%, in low-use areas (difference: 95% CI, -1.8% to 2.4%), and the 15-year overall survival was 8.6% in high-use areas vs 9.2% in low-use areas (difference: 95% CI, -1.5% to 0.4%). CONCLUSIONS AND RELEVANCE Primary ADT is not associated with improved long-term overall or disease-specific survival for men with localized prostate cancer. Primary ADT should be used only to palliate symptoms of disease or prevent imminent symptoms associated with disease progression.
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Affiliation(s)
- Grace L Lu-Yao
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey3Department of Epidemiology, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick6The Dean and Betty
| | - Peter C Albertsen
- Department of Surgery (Urology), University of Connecticut Health Center, Farmington
| | - Dirk F Moore
- Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Weichung Shih
- Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Yong Lin
- Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Robert S DiPaola
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick6The Dean and Betty Gallo Prostate Cancer Center, New Brunswick, New Jersey
| | - Siu-Long Yao
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick7Merck Research Laboratories, Kenilworth, New Jersey
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Polednak AP. Inaccuracies in oral cavity-pharynx cancer coded as the underlying cause of death on U.S. death certificates, and trends in mortality rates (1999-2010). Oral Oncol 2014; 50:732-9. [PMID: 24862544 DOI: 10.1016/j.oraloncology.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/04/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To enhance surveillance of mortality from oral cavity-pharynx cancer (OCPC) by considering inaccuracies in the cancer site coded as the underlying cause of death on death certificates vs. cancer site in a population-based cancer registry (as the gold standard). METHODS A database was used for 9 population-based cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, including deaths in 1999-2010 for patients diagnosed in 1973-2010. Numbers of deaths and death rates for OCPC in the SEER population were modified for apparent inaccuracies in the cancer site coded as the underlying cause of death. RESULTS For age groups <65 years, deaths from OCPC were underestimated by 22-35% by using unmodified (vs. modified) numbers, but temporal declines in death rates were still evident in the SEER population and were similar to declines using routine mortality data for the entire U.S. population. Deaths were underestimated by about 70-80% using underlying cause for tonsillar cancers, strongly associated with human papillomavirus (HPV) infection, but a lack of decline in death rates was still evident. CONCLUSION Routine mortality statistics based on underlying cause of death underestimate OCPC deaths but demonstrate trends in OCPC death rates that require continued surveillance in view of increasing incidence rates for HPV-related OCPC.
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Affiliation(s)
- Anthony P Polednak
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, United States (Retired).
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Mahal BA, Aizer AA, Ziehr DR, Hyatt AS, Choueiri TK, Hu JC, Hoffman KE, Sweeney CJ, Beard CJ, D'Amico AV, Martin NE, Kim SP, Trinh QD, Nguyen PL. Racial disparities in prostate cancer-specific mortality in men with low-risk prostate cancer. Clin Genitourin Cancer 2014; 12:e189-95. [PMID: 24861952 DOI: 10.1016/j.clgc.2014.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/24/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Men with low-risk prostate cancer (CaP) are considered unlikely to die of CaP and have the option of active surveillance. This study evaluated whether African American (AA) men who present with low-risk disease are at higher risk for death from CaP than white men. PATIENTS AND METHODS The authors identified 56,045 men with low-risk CaP (T1-T2a, Gleason score ≤ 6, prostate-specific antigen ≤ 10 ng/mL) diagnosed between 2004 and 2009 using the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing-risks regression analyses were used to analyze the effect of race on prostate cancer-specific mortality (PCSM) after adjusting for known prognostic and sociodemographic factors in 51,315 men (43,792 white; 7523 AA) with clinical follow-up information available. RESULTS After a median follow-up of 46 months, 258 patients (209 [0.48%] white and 49 [0.65%] AA men) died from CaP. Both AA race (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.03-2.05; P = .032) and noncurative management (AHR, 1.49; 95% CI, 1.15-1.95; P = .003) were significantly associated with an increased risk of PCSM. When analyzing only patients who underwent curative treatment, AA race (AHR, 1.62; 95% CI, 1.04-2.53; P = .034) remained significantly associated with increased PCSM. CONCLUSION Among men with low-risk prostate cancer, AA race compared with white race was associated with a higher risk of PCSM, raising the possibility that clinicians may need to exercise caution when recommending active surveillance for AA men with low-risk disease. Further studies are needed to ultimately determine whether guidelines for active surveillance should take race into account.
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Affiliation(s)
| | | | | | - Andrew S Hyatt
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jim C Hu
- Department of Urology, University of California Los Angeles Medical Center, Los Angeles, CA
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Simon P Kim
- Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Huang J, Detterbeck FC, Wang Z, Loehrer PJ. [Standard outcome measures for thymic malignancies]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:122-9. [PMID: 24581163 PMCID: PMC6131238 DOI: 10.3779/j.issn.1009-3419.2014.02.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James Huang
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine and Department of Biostatistics, School of Epidemiology and Public Health, Yale University, New Haven, Connecticut
| | - Frank C Detterbeck
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Zuoheng Wang
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Patrick J Loehrer
- HH Gregg Professor of Oncology, Division of Medical Oncology, Department of Internal Medicine, Indiana Universitychool of Medicine, Indianapolis, Indiana
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Yu O, Eberg M, Benayoun S, Aprikian A, Batist G, Suissa S, Azoulay L. Use of statins and the risk of death in patients with prostate cancer. J Clin Oncol 2013; 32:5-11. [PMID: 24190110 DOI: 10.1200/jco.2013.49.4757] [Citation(s) in RCA: 391] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To determine whether the use of statins after prostate cancer diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality and to assess whether this association is modified by prediagnostic use of statins. PATIENTS AND METHODS A cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April 1, 1998, and December 31, 2009, followed until October 1, 2012, was identified using a large population-based electronic database from the United Kingdom. Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs of mortality outcomes associated with postdiagnostic use of statins, lagged by 1 year to account for latency considerations and to minimize reverse causality, and considering effect modification by prediagnostic use of statins. RESULTS During a mean follow-up time of 4.4 years (standard deviation, 2.9 years), 3,499 deaths occurred, including 1,791 from prostate cancer. Postdiagnostic use of statins was associated with a decreased risk of prostate cancer mortality (HR, 0.76; 95% CI, 0.66 to 0.88) and all-cause mortality (HR, 0.86; 95% CI, 0.78 to 0.95). These decreased risks of prostate cancer mortality and all-cause mortality were more pronounced in patients who also used statins before diagnosis (HR, 0.55; 95% CI, 0.41 to 0.74; and HR, 0.66; 95% CI, 0.53 to 0.81, respectively), with weaker effects in patients who initiated the treatment only after diagnosis (HR, 0.82; 95% CI, 0.71 to 0.96; and HR, 0.91; 95% CI, 0.82 to 1.01, respectively). CONCLUSION Overall, the use of statins after diagnosis was associated with a decreased risk in prostate cancer mortality. However, this effect was stronger in patients who also used statins before diagnosis.
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Affiliation(s)
- Oriana Yu
- Oriana Yu, Maria Eberg, Samy Suissa, and Laurent Azoulay, Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital; Oriana Yu, Jewish General Hospital; Oriana Yu, Armen Aprikian, Gerald Batist, Samy Suissa, and Laurent Azoulay, McGill University; Serge Benayoun, University of Montreal; Armen Aprikian, McGill University Health Centre, McGill University; Gerald Batist and Laurent Azoulay, Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
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Barry MJ, Andriole GL, Culkin DJ, Fox SH, Jones KM, Carlyle MH, Wilt TJ. Ascertaining cause of death among men in the Prostate Cancer Intervention Versus Observation Trial. Clin Trials 2013; 10:907-14. [DOI: 10.1177/1740774513498008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Prostate Cancer Intervention Versus Observation Trial (PIVOT) randomized 731 men with localized prostate cancer to radical prostatectomy or observation. Purpose We describe the methods and results for cause-of-death assignments in PIVOT, and compare them to alternative strategies for ascertaining prostate cancer–specific mortality, as well as to the methods and results in the similar Scandinavian Prostate Cancer Group Study 4 (SPCG-4) trial. Methods Three PIVOT Endpoints Committee members, blinded to randomized treatment assignments, reviewed medical records and death certificates when available to assign a cause of death using a primary and a secondary adjudication question. Initial disagreements were resolved through discussion. The level of initial agreement among committee members was examined, as well as guesses at randomized treatment assignments for a convenience sample of cases. Final cause of death determinations were compared to death certificates. Results Complete agreement on cause of death by all three committee members before any discussion was achieved in 200/354 (56%) cases on the primary and 209/354 (59%) cases on the secondary. However, complete agreement on the primary rose to 306/354 (86%) when ‘definite’ and ‘probably’ categories were collapsed, as planned a priori. The three committee members’ proportions of correct guesses of randomized treatment assignment were 82/121 (68%), 113/148 (76%), and 99/134 (74%). Using the committee’s final adjudications as a gold standard, death certificates had suboptimal sensitivities, specificities, or predictive values depending on how they were used to determine cause of death. Limitations There was no separate ‘gold standard’ by which to judge the accuracy of the final endpoints committee adjudications, and useful death certificates could not be obtained on about a third of PIVOT participants who died. Conclusions The low level of initial agreement on cause of death among endpoint committee members and the potential for biased determinations due to partial unblinding to treatment assignment raise methodologic concerns about using prostate cancer mortality as an endpoint in clinical trials like PIVOT.
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Affiliation(s)
- Michael J Barry
- General Medicine Division, Massachusetts General Hospital, Boston, MA, USA
| | - Gerald L Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel J Culkin
- Department of Urology, The Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Steven H Fox
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Karen M Jones
- Department of Veterans Affairs Medical Center, Cooperative Studies Coordinating Center, Perry Point, MD, USA
| | - Maureen H Carlyle
- Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA
| | - Timothy J Wilt
- Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA
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Sun M, Sammon JD, Becker A, Roghmann F, Tian Z, Kim SP, Larouche A, Abdollah F, Hu JC, Karakiewicz PI, Trinh QD. Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: a comparative effectiveness evaluation. BJU Int 2013; 113:200-8. [DOI: 10.1111/bju.12321] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Jesse D. Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation; Henry Ford Health Systems; Detroit MI USA
| | - Andreas Becker
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Florian Roghmann
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Simon P. Kim
- Department of Urology; Yale University; New Haven CT USA
| | - Alexandre Larouche
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Firas Abdollah
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Department of Urology; University of Montreal Health Center; Montreal Canada
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology; Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School; Boston MA USA
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Chowdhury S, Robinson D, Cahill D, Rodriguez-Vida A, Holmberg L, Møller H. Causes of death in men with prostate cancer: an analysis of 50 000 men from the Thames Cancer Registry. BJU Int 2013; 112:182-9. [DOI: 10.1111/bju.12212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Simon Chowdhury
- Department of Medical Oncology; Guy's Hospital; King's College London; London; UK
| | - David Robinson
- Thames Cancer Registry; Section of Cancer Epidemiology; London; UK
| | - Declan Cahill
- Department of Urology; Guy's Hospital; King's College London; London; UK
| | - Alejo Rodriguez-Vida
- Department of Medical Oncology; Guy's Hospital; King's College London; London; UK
| | | | - Henrik Møller
- Thames Cancer Registry; Section of Cancer Epidemiology; London; UK
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DeGroot JM, Brundage MD, Lam M, Rohland SL, Heaton J, Mackillop WJ, Siemens DR, Groome PA. Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy. Can Urol Assoc J 2013; 7:E299-305. [PMID: 23766831 PMCID: PMC3668411 DOI: 10.5489/cuaj.11294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We compared the cause-specific survival of patients who received radiotherapy to those who received surgery for cure of their prostate cancer using a number of design and analytic steps to mitigate confounding by indication. METHODS This was a case-cohort study of 2213 patients in the Ontario Cancer Registry diagnosed between 1990 and 1998 who were either treatment candidates or received curative radiotherapy or surgery. Cases included patients who died of prostate cancer within 10 years. The study population was restricted to those who were candidates for either treatment (radiotherapy or surgery) based on disease severity (low and intermediate risk using the Genitourinary Radiation Oncologists of Canada risk groups). The median follow-up was 51 months. Cause-specific survival was analyzed using Cox-proportional hazards regression with case-cohort variance adjustment. Results from intent-to-treat analyses were compared to results by treatment received. RESULTS Adjusted hazard ratios for risk of prostate cancer death for radiotherapy compared to surgery for the entire study population were 1.62 (95%CI 1.00-2.61) and 2.02 (1.19-3.43) analyzing by intent-to-treat and treatment received, respectively. Intent-to-treat hazard ratios for the low- and intermediate-risk groups were 0.87 (0.28-2.76) and 1.57 (0.95-2.61), respectively. CONCLUSION Overall results were driven by the finding in the intermediate-risk group, which indicated that radiotherapy was not as effective as surgery in this group. Confirmation was needed with special attention paid to risk stratification and the impact of more contemporary delivery of these treatment options.
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Affiliation(s)
- Julie M. DeGroot
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Michael D. Brundage
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Miu Lam
- Department of Community Health and Epidemiology, Queen’s University, Kingston, ON
| | - Susan L. Rohland
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Jeremy Heaton
- Department of Urology, Queen’s University, Kingston, ON
| | - William J. Mackillop
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | | | - Patti A. Groome
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
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Briganti A, Spahn M, Joniau S, Gontero P, Bianchi M, Kneitz B, Chun FK, Sun M, Graefen M, Abdollah F, Marchioro G, Frohenberg D, Giona S, Frea B, Karakiewicz PI, Montorsi F, Van Poppel H, Jeffrey Karnes R. Impact of Age and Comorbidities on Long-term Survival of Patients with High-risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-institutional Competing-risks Analysis. Eur Urol 2013; 63:693-701. [DOI: 10.1016/j.eururo.2012.08.054] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/27/2012] [Indexed: 11/12/2022]
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Sun M, Becker A, Tian Z, Roghmann F, Abdollah F, Larouche A, Karakiewicz PI, Trinh QD. Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol 2013; 65:235-41. [PMID: 23567066 DOI: 10.1016/j.eururo.2013.03.034] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/15/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND For elderly individuals with localized renal cell carcinoma (RCC), surgical intervention remains the primary treatment option but may not benefit patients with limited life expectancy. OBJECTIVE To calculate the trade-offs between surgical excision and nonsurgical management (NSM) with respect to competing causes of mortality. DESIGN, SETTING, AND PARTICIPANTS Relying on a cohort of Medicare beneficiaries, all patients with nonmetastatic node-negative T1 RCC between 1988 and 2005 were abstracted. INTERVENTION All patients were treated with partial nephrectomy (PN), radical nephrectomy (RN), or NSM. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were modeled through competing-risks regression methodologies. Instrumental variable analysis was used to account for the potential biases associated with measured and unmeasured confounders. RESULTS AND LIMITATIONS A total of 10 595 patients were identified. In instrumental variable analysis, patients treated with PN (hazard ratio [HR]: 0.45; 95% confidence interval [CI], 0.24-0.83; p=0.01) or RN (HR: 0.58; 95% CI, 0.35-0.96; p=0.03) had a significantly lower risk of CSM than those treated with NSM. In subanalyses restricted to patients ≥ 75 yr, the instrumental variable analysis failed to detect any statistically significant difference between PN (HR: 0.48; p=0.1) or RN (HR: 0.57; p=0.1) relative to NSM with respect to CSM. Similar trends were observed in T1a RCC only. CONCLUSIONS PN or RN is associated with a reduction of CSM among older patients diagnosed with localized RCC, compared with NSM. The same benefit failed to reach statistical significance among patients ≥ 75 yr. The harms of surgery need to be weighed against the marginal survival benefit for some patients.
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Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Canada.
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Aizer AA, Chen MH, Hattangadi J, D'Amico AV. Initial management of prostate-specific antigen-detected, low-risk prostate cancer and the risk of death from prostate cancer. BJU Int 2013; 113:43-50. [PMID: 23473327 DOI: 10.1111/j.1464-410x.2012.11789.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The recently published Prostate Cancer Intervention versus Observation Trial (PIVOT) did not identify differences in prostate cancer-specific mortality or all-cause mortality among patients with low-risk disease managed conservatively vs those managed definitively; however, recently published data suggest that older men may harbour more aggressive disease than is identified at biopsy owing to sampling error and undergrading. Whether older men with apparent low-risk disease are placed at risk of prostate cancer-specific mortality when managed conservatively remains unknown. The study used population-level data to show that non-curative approaches for older men with low-risk prostate cancer do result in an increased risk of prostate cancer-specific mortality. Differences between our study and the PIVOT trial include the fact that we included a larger sample size, analysed the data using an 'as-treated' approach, and included a healthier cohort of men as evinced by lower 4-year all-cause mortality estimates in our study than in the PIVOT. Our results suggest that older men with apparent low-risk prostate cancer are at risk of undergrading, which probably explains the differences in prostate cancer-specific mortality observed between men managed conservatively vs those managed definitively. Our study suggests that alternative approaches to excluding occult, high grade prostate cancer are needed in such men. OBJECTIVE To evaluate whether older age in men with low-risk prostate cancer increases the risk of prostate cancer-specific mortality (PCSM) when non-curative approaches are selected as initial management. PATIENTS AND METHODS The study cohort consisted of 27 969 men, with a median age of 67 years, with prostate-specific antigen (PSA)-detected, low-risk prostate cancer (clinical category T1c, Gleason score ≤6, and PSA ≤10) identified by the Surveillance, Epidemiology and End Results programme between 2004 and 2007. Fine and Gray's competing risk regression analysis was used to evaluate whether management with non-curative vs curative therapy was associated with an increased risk of PCSM after adjusting for PSA level, age at diagnosis and year of diagnosis. RESULTS After a median follow-up of 2.75 years, 1121 men died, 60 (5.4%) from prostate cancer. Both older age (adjusted hazard ratio [AHR] 1.05; 95% confidence interval (CI) 1.02-1.08; P < 0.001) and non-curative treatment (AHR 3.34; 95% CI 1.97-5.67; P < 0.001) were significantly associated with an increased risk of PCSM. Men > the median age experienced increased estimates of PCSM when treated with non-curative as opposed to curative intent (P < 0.001); this finding was not seen in men ≤ the median age (P = 0.17). CONCLUSION Pending prospective validation, our study suggests that non-curative approaches for older men with 'low-risk' prostate cancer result in an increased risk of PCSM, suggesting the need for alternative approaches to exclude occult, high grade prostate cancer in these men.
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Kendal WS, Kendal WM. Comparative Risk Factors for Accidental and Suicidal Death in Cancer Patients. CRISIS 2012; 33:325-34. [DOI: 10.1027/0227-5910/a000149] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Cancer patients appear at higher risk of accidental death and suicide. The reasons for this and how suicide and accidental death relate remain unclear. Aims: To clarify and contrast risk factors for such deaths among cancer patients. Methods: A SEER (1973–2007) analysis was conducted on 4,449,957 cancer patients comparing all causes of death (COD) to accidental and suicidal deaths through competing hazards, relative risk and proportional hazards models. SEER did not provide psychological assessments; the analysis was confined to their standard epidemiological and clinicopathological parameters. Results: 2,557,385 overall deaths yielded 16,879 (0.66%) accidents and 6,589 (0.26%) suicides. Mortality reached its highest incidence immediately after diagnosis and obeyed Pareto type II distributions. The major identifiable risk factor for suicide was male gender; for accidental death, First Nations ethnicity; and all COD, metastases. Minor factors for suicide included metastases, advanced age, and respiratory as well as head and neck tumors, whereas for accidental death they were male gender, metastases, advanced age, and brain tumors. Conclusions: Differences were observed in the risk patterns of suicide and accidental death, suggesting distinct etiologies. A high incidence of suicides and accidental deaths following diagnosis (attributed by some to stress from the diagnosis of cancer) correlated here with overall mortality and indicators of physical morbidity. Cancer patients with the above identifiable risk factors warrant supportive attention.
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Affiliation(s)
- Wayne S. Kendal
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa, Canada
- The Ottawa Hospital Research Institute, Canada
| | - Wendy M. Kendal
- Department of Family and Community Medicine, St. Paul’s Hospital, Vancouver, Canada
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Russo AL, Chen MH, Aizer AA, Hattangadi JA, D'Amico AV. Advancing age within established Gleason score categories and the risk of prostate cancer-specific mortality (PCSM). BJU Int 2012; 110:973-9. [DOI: 10.1111/j.1464-410x.2012.11470.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sun M, Abdollah F, Bianchi M, Trinh QD, Shariat SF, Jeldres C, Tian Z, Hansen J, Briganti A, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Conditional survival of patients with urothelial carcinoma of the urinary bladder treated with radical cystectomy. Eur J Cancer 2012; 48:1503-11. [DOI: 10.1016/j.ejca.2011.11.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/22/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
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Sun M, Bianchi M, Trinh QD, Hansen J, Abdollah F, Hanna N, Tian Z, Shariat SF, Montorsi F, Perrotte P, Karakiewicz PI. Comparison of partial vs radical nephrectomy with regard to other-cause mortality in T1 renal cell carcinoma among patients aged ≥75 years with multiple comorbidities. BJU Int 2012; 111:67-73. [PMID: 22612472 DOI: 10.1111/j.1464-410x.2012.11254.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify the effect of partial nephrectomy (PN) vs radical nephrectomy (RN) on other-cause mortality (OCM) in elderly patients with localized renal cell carcinoma (RCC) and/or multiple comorbidities. METHODS Using the Surveillance, Epidemiology, and End Results Medicare-linked database, patients with T1 RCC, aged ≥75 years, or who had ≥2 comorbidities, were identified (1988-2005). To adjust for inherent differences between treatment types, propensity-based matched analyses were performed. Competing-risks regression analyses for prediction of OCM were assessed according to treatment type. The effect of PN and RN on OCM was examined in three sub-groups: patients aged ≥75 years; patients with ≥2 comorbidities; and patients aged ≥75 years with ≥2 comorbidities. RESULTS After propensity-based matched analyses and adjustment for all covariates, PN was found to exert a protective effect relative to RN with respect to OCM in all patients (hazard ratio [HR]: 0.84, P = 0.048). In subanalyses, no difference was recorded between PN and RN in patients who were aged ≥75 years (HR: 0.83, P = 0.2), with ≥2 baseline comorbidities at diagnosis (HR: 0.83, P = 0.1), or in patients who were aged ≥75 years and who had ≥2 baseline comorbidities (HR: 0.77, P = 0.2). CONCLUSIONS Some elderly patients and/or those with multiple comorbidities at diagnosis may not benefit from PN with respect to OCM. After rigorous patient selection, alternative treatment options could be considered.
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Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
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Howrey BT, Kuo YF, Lin YL, Goodwin JS. The impact of PSA screening on prostate cancer mortality and overdiagnosis of prostate cancer in the United States. J Gerontol A Biol Sci Med Sci 2012; 68:56-61. [PMID: 22562961 DOI: 10.1093/gerona/gls135] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer. METHODS We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007. RESULTS Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p < .001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results. CONCLUSIONS PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing.
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Affiliation(s)
- Bret T Howrey
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77555-0177, USA
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