1
|
Vince RA, Jiang R, Bank M, Quarles J, Patel M, Sun Y, Hartman H, Zaorsky NG, Jia A, Shoag J, Dess RT, Mahal BA, Stensland K, Eyrich NW, Seymore M, Takele R, Morgan TM, Schipper M, Spratt DE. Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2250416. [PMID: 36630135 PMCID: PMC9857531 DOI: 10.1001/jamanetworkopen.2022.50416] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE As the field of medicine strives for equity in care, research showing the association of social determinants of health (SDOH) with poorer health care outcomes is needed to better inform quality improvement strategies. OBJECTIVE To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer. DATA SOURCES A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020. STUDY SELECTION Two authors independently selected studies conducted among patients within the United States and performed comparative outcome analysis between Black and White patients. Studies were required to report time-to-event outcomes. A total of 251 studies were identified for review. DATA EXTRACTION AND SYNTHESIS Three authors independently screened and extracted data. End point meta-analyses were performed using both fixed-effects and random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed, and 2 authors independently reviewed all steps. All conflicts were resolved by consensus. MAIN OUTCOMES AND MEASURES The primary outcome was PCSM, and the secondary outcome was OS. With the US Department of Health and Human Services Healthy People 2030 initiative, an SDOH scoring system was incorporated to evaluate the association of SDOH with the predefined end points. The covariables included in the scoring system were age, comorbidities, insurance status, income status, extent of disease, geography, standardized treatment, and equitable and harmonized insurance benefits. The scoring system was discretized into 3 categories: high (≥10 points), intermediate (5-9 points), and low (<5 points). RESULTS The 47 studies identified comprised 1 019 908 patients (176 028 Black men and 843 880 White men; median age, 66.4 years [IQR, 64.8-69.0 years]). The median follow-up was 66.0 months (IQR, 41.5-91.4 months). Pooled estimates found no statistically significant difference in PCSM for Black patients compared with White patients (hazard ratio [HR], 1.08 [95% CI, 0.99-1.19]; P = .08); results were similar for OS (HR, 1.01 [95% CI, 0.95-1.07]; P = .68). There was a significant race-SDOH interaction for both PCSM (regression coefficient, -0.041 [95% CI, -0.059 to 0.023]; P < .001) and OS (meta-regression coefficient, -0.017 [95% CI, -0.033 to -0.002]; P = .03). In studies with minimal accounting for SDOH (<5-point score), Black patients had significantly higher PCSM compared with White patients (HR, 1.29; 95% CI, 1.17-1.41; P < .001). In studies with greater accounting for SDOH variables (≥10-point score), PCSM was significantly lower among Black patients compared with White patients (HR, 0.86; 95% CI, 0.77-0.96; P = .02). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis suggest that there is a significant interaction between race and SDOH with respect to PCSM and OS among men with prostate cancer. Incorporating SDOH variables into data collection and analyses are vital to developing strategies for achieving equity.
Collapse
Affiliation(s)
- Randy A. Vince
- Department of Urology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Ralph Jiang
- Department of Biostatics, University of Michigan, Ann Arbor
| | | | - Jake Quarles
- Central Michigan University School of Medicine, Mt Pleasant
| | - Milan Patel
- University of Michigan School of Medicine, Ann Arbor
| | - Yilun Sun
- Department of Population Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Holly Hartman
- Department of Population Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Angela Jia
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan Shoag
- Department of Urology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Robert T. Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | | | - Nicholas W. Eyrich
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Rebecca Takele
- Department of General Surgery, Albany Medical College, Albany, New York
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
2
|
Outcome of primary androgen deprivation therapy in super-elderly men with localized high-risk prostate cancer. Anticancer Drugs 2022; 33:534-538. [PMID: 35276692 DOI: 10.1097/cad.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to provide certain data on clinical outcome of primary androgen deprivation therapy in men over 80 years of age with localized high-risk prostate cancer. This study included 54 Japanese super-elderly men with high-risk prostate cancer treated with primary androgen deprivation therapy between 2005 and 2015. The median overall survival was 9.1 years (95% confidence interval, 8.1-10.1) and no patient died from prostate cancer. Overall, 51.9% of patients experienced any grade of adverse events following androgen deprivation therapy. Associations between clinicopathological factors including comorbidity count at initial diagnosis and overall survival were investigated. On multivariate analysis, only comorbidity count at initial diagnosis [≥2 vs. ≤1; hazard ratio, 5.34 (95% confidence interval, 1.55-18.49); P = 0.003] was an independent risk factor for overall survival. Our findings suggest that comorbidity count at initial diagnosis is robustly prognostic for overall survival. For super-elderly men with localized high-risk prostate cancer, comorbidity count at initial diagnosis should be emphasized when deciding whether primary androgen deprivation therapy is necessary or not.
Collapse
|
3
|
Yao J, Liu Y, Liang X, Shao J, Zhang Y, Yang J, Zheng M. Neuroendocrine Carcinoma as an Independent Prognostic Factor for Patients With Prostate Cancer: A Population-Based Study. Front Endocrinol (Lausanne) 2021; 12:778758. [PMID: 34956090 PMCID: PMC8692830 DOI: 10.3389/fendo.2021.778758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neuroendocrine carcinoma (NEC) is a rare and highly malignant variation of prostate adenocarcinoma. We aimed to investigate the prognostic value of NEC in prostate cancer. METHODS A total of 530440 patients of prostate cancer, including neuroendocrine prostate cancer (NEPC) and adenocarcinoma from 2004 to 2018 were obtained from the national Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM), multivariable Cox proportional hazard model, Kaplan-Meier method and subgroup analysis were performed in our study. RESULTS NEPC patients were inclined to be older at diagnosis (Median age, 69(61-77) vs. 65(59-72), P< 0.001) and had higher rates of muscle invasive disease (30.9% vs. 9.2%, P < 0.001), lymph node metastasis (32.2% vs. 2.2%, P < 0.001), and distal metastasis (45.7% vs. 3.6%, P < 0.001) compared with prostate adenocarcinoma patients. However, the proportion of NEPC patients with PSA levels higher than 4.0 ng/mL was significantly less than adenocarcinoma patients (47.3% vs. 72.9%, P<0.001). NEPC patients had a lower rate of receiving surgery treatment (28.8% vs. 43.9%, P<0.001), but they had an obviously higher rate of receiving chemotherapy (57.9% vs. 1.0%, P<0.001). A Cox regression analysis demonstrated that the NEPC patients faced a remarkably worse OS (HR = 2.78, 95% CI = 2.34-3.31, P < 0.001) and CSS (HR = 3.07, 95% CI = 2.55-3.71, P < 0.001) compared with adenocarcinoma patients after PSM. Subgroup analyses further suggested that NEPC patients obtained significantly poorer prognosis across nearly all subgroups. CONCLUSION The prognosis of NEPC was worse than that of adenocarcinoma among patients with prostate cancer. The histological subtype of NEC is an independent prognostic factor for patients with prostate cancer.
Collapse
|
4
|
Cobran EK, Young HN, Chen RC, Chen X, Reeves J, Godley PA, Shah S. Race and Time to Receipt of Androgen Deprivation Therapy Among Men With Metastatic Prostate Cancer. J Natl Med Assoc 2018; 111:246-255. [PMID: 30389146 DOI: 10.1016/j.jnma.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT. METHODS The purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare. RESULTS A total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region. CONCLUSION Considering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.
Collapse
Affiliation(s)
- Ewan K Cobran
- University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270B, Athens, GA 30602, USA.
| | - Henry N Young
- University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Robert C. Wilson Pharmacy 250 West Green Street, 270J, Athens, GA 30602, USA
| | - Ronald C Chen
- University of North Carolina at Chapel Hill, School of Medicine, Department of Radiation Oncology and Urology, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Xianyan Chen
- University of Georgia, Franklin College of Arts and Sciences, Department of Statistics, Statistical Consulting Center, 310 Herty Drive, Athens, GA 30602, USA
| | - Jaxk Reeves
- University of Georgia, Franklin College of Arts and Sciences, Department of Statistics, Statistical Consulting Center, 310 Herty Drive, Athens, GA 30602, USA
| | - Paul A Godley
- University of North Carolina at Chapel Hill, School of Medicine, Department of Hematology and Oncology, 4064 Bondurant Hall, Chapel Hill, NC 27514, USA
| | - Surbhi Shah
- Evidera, Real-World Evidence, 500 Totten Pond Road, Waltham, MA 02451, USA
| |
Collapse
|
5
|
Ortelli L, Spitale A, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland. BMC Cancer 2018; 18:733. [PMID: 29996904 PMCID: PMC6042390 DOI: 10.1186/s12885-018-4604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Quality of cancer care (QoCC) has become an important item for providers, regulators and purchasers of care worldwide. Aim of this study is to present the results of some evidence-based quality indicators (QI) for prostate cancer (PC) at the population-based level and to compare the outcomes with data available in the literature. Methods The study included all PC diagnosed on a three years period analysis (01.01.2011–31.12.2013) in the population of Canton Ticino (Southern Switzerland) extracted from the Ticino Cancer Registry database. 13 QI, approved through the validated Delphi methodology, were calculated using the “available case” approach: 2 for diagnosis, 4 for pathology, 6 for treatment and 1 for outcome. The selection of the computed QI was based on the availability of medical documentation. QI are presented as proportion (%) with the corresponding 95% confidence interval. Results 700 PC were detected during the three-year period 2011–2013: 78.3% of them were diagnosed through a prostatic biopsy and for 72.5% 8 or more biopsy cores were taken. 46.5% of the low risk PC patients underwent active surveillance, while 69.2% of high risk PC underwent a radical treatment (radical prostatectomy, radiotherapy or brachytherapy) and 73.5% of patients with metastatic PC were treated with hormonal therapy. The overall 30-day postoperative mortality was 0.5%. Conclusions Results emerging from this study on the QoCC for PC in Canton Ticino are encouraging: the choice of treatment modalities seems to respect the international guidelines and our results are comparable to the scarce number of available international studies. Additional national and international standardisation of the QI and further QI population-based studies are needed in order to get a real picture of the PC diagnostic-therapeutic process progress through the definition of thresholds of minimal standard of care. Electronic supplementary material The online version of this article (10.1186/s12885-018-4604-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Ortelli
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland.
| | - Alessandra Spitale
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
| | - Luca Mazzucchelli
- Clinical Pathology, Cantonal Institute of Pathology, 6600, Locarno, Switzerland
| | - Andrea Bordoni
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
| |
Collapse
|
6
|
Bradley MC, Zhou Y, Freedman AN, Yood MU, Quesenbery CP, Haque R, Van Den Eeden SK, Cassidy-Bushrow AE, Aaronson D, Potosky AL. Risk of diabetes complications among those with diabetes receiving androgen deprivation therapy for localized prostate cancer. Cancer Causes Control 2018; 29:785-791. [PMID: 29959604 DOI: 10.1007/s10552-018-1050-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/13/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Androgen deprivation therapy (ADT), used increasingly in the treatment of localized prostate cancer, is associated with substantial long-term adverse consequences, including incident diabetes. While previous studies have suggested that ADT negatively influences glycemic control in existing diabetes, its association with diabetes complications has not been investigated. In this study, we examined the association between ADT use and diabetes complications in prostate cancer patients. METHODS A retrospective cohort study was conducted among men with newly diagnosed localized prostate cancer between 1995 and 2008, enrolled in three integrated health care systems. Men had radical prostatectomy or radiotherapy (curative intent therapy), existing type II diabetes mellitus (T2DM), and were followed through December 2010 (n = 5,336). Cox proportional hazards models were used to examine associations between ADT use and diabetes complications (any complication), and individual complications (diabetic neuropathy, diabetic retinopathy, diabetic amputation or diabetic cataract) after prostate cancer diagnosis. RESULTS ADT use was associated with an increased risk of any diabetes complication after prostate cancer diagnosis (adjusted hazard ratio, AHR, 1.12, 95% CI 1.03-1.23) as well as an increased risk of each individual complication compared to non-use. CONCLUSION ADT use in men with T2DM, who received curative intent therapy for prostate cancer, was associated with an increased risk of diabetes complications. These findings support those of previous studies, which showed that ADT worsened diabetes control. Additional, larger studies are required to confirm these findings and to potentially inform the development of a risk-benefit assessment for men with existing T2DM, before initiating ADT.
Collapse
Affiliation(s)
- Marie C Bradley
- Clinical and Translational Epidemiology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
| | - Yingjun Zhou
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Andrew N Freedman
- Clinical and Translational Epidemiology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - David Aaronson
- Kaiser Permanente, Oakland Medical Center, 3600 Broadway, Oakland, CA, USA
| | - Arnold L Potosky
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| |
Collapse
|
7
|
Nguyen C, Lairson DR, Swartz MD, Du XL. Racial, Socioeconomic, and Geographic Disparities in the Receipt, Timing to Initiation, and Duration of Adjuvant Androgen Deprivation Therapy in Men with Prostate Cancer. J Racial Ethn Health Disparities 2018; 6:133-142. [PMID: 29959759 DOI: 10.1007/s40615-018-0508-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This retrospective cohort study aims to examine the receipt, timing to initiation, and duration of androgen deprivation therapy (ADT) in men with prostate cancer by race/ethnicity, socioeconomic status, and geographic location. METHODS The study population are patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, who were 66 years or older and newly diagnosed with stage III and IV prostate cancer in 1992-2009 and underwent radiation therapy, where ADT was proven to be highly beneficial and its use was considered as most appropriate (n = 12,170). We use logistic regression to examine the receipt of ADT and linear regression to study factors associated with time to ADT initiation while controlling for baseline characteristics. RESULTS Overall, 77% of eligible patients received at least one form of ADT in combination with radiation therapy, of which 12% underwent orchiectomy and the rest received ADT, and 77.2% of non-Hispanic white and 80.7% of Hispanic patients received ADT compared to 73.8% of non-Hispanic black. After adjustment for demographic and tumor characteristics, black men and men of other races are less likely to receive ADT compared to white counterparts (OR = 0.64 and 0.74, respectively). The median time from cancer diagnosis to ADT initiation is 2 months. Once initiated, men received a median of seven drug injections. After controlling for covariates, race/ethnicity and geographic location (SEER areas) are associated with early initiation of therapy. White, Hispanic men and men living in the South initiate ADT earlier. CONCLUSION Significant racial disparities exist in the receipt and use of this highly beneficial therapy, and there are geographic variations in the utilization of this therapy.
Collapse
Affiliation(s)
- Chi Nguyen
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, University of Texas Health Science Center in Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA
| | - David R Lairson
- Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, 77030, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, 77030, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, University of Texas Health Science Center in Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA.
| |
Collapse
|
8
|
Taaffe DR, Buffart LM, Newton RU, Spry N, Denham J, Joseph D, Lamb D, Chambers SK, Galvão DA. Time on androgen deprivation therapy and adaptations to exercise: secondary analysis from a 12‐month randomized controlled trial in men with prostate cancer. BJU Int 2017; 121:194-202. [DOI: 10.1111/bju.14008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dennis R. Taaffe
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
- School of Human Movement and Nutrition Sciences University of Queensland Brisbane Qld Australia
| | - Laurien M. Buffart
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Departments of Epidemiology and Biostatistics and Medical Oncology VU University Medical Centre Amsterdam The Netherlands
| | - Robert U. Newton
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
- Institute of Human Performance University of Hong Kong Hong Kong Hong Kong
- University of Queensland Centre for Clinical Research University of Queensland Brisbane Qld Australia
| | - Nigel Spry
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Genesis CancerCare Joondalup WA Australia
- Faculty of Medicine University of Western Australia Nedlands WA Australia
| | - James Denham
- School of Medicine and Public Health University of Newcastle Callaghan NSW Australia
- Newcastle Mater Hospital Newcastle NSW Australia
| | - David Joseph
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Faculty of Medicine University of Western Australia Nedlands WA Australia
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands WA Australia
| | - David Lamb
- University of Otago Wellington New Zealand
| | - Suzanne K. Chambers
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Qld Australia
- Centre for Research in Cancer Cancer Council Queensland Brisbane Qld Australia
- Prostate Cancer Foundation of Australia Sydney NSW Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
| |
Collapse
|
9
|
Use of androgen deprivation therapy as salvage treatment after primary therapy for clinically localized prostate cancer. World J Urol 2016; 34:1611-1619. [PMID: 27084777 DOI: 10.1007/s00345-016-1823-5] [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: 10/16/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The optimal use of androgen deprivation therapy as salvage treatment (sADT) for men after initial prostatectomy or radiotherapy for clinically localized prostate cancer is undefined. We describe patterns of sADT use and investigate clinical and sociodemographic characteristics of insured men who received sADT versus surveillance in managed care settings. METHODS Using comprehensive electronic health records and cancer registry data from three integrated health plans, we identified all men with newly diagnosed clinically localized prostate cancer between 1995 and 2009 who received either prostatectomy (n = 16,445) or radiotherapy (n = 19,531) as their primary therapy. We defined sADT based on the timing of ADT following primary therapy and stage of cancer. We fit Cox proportional hazard models to identify sociodemographic characteristics and clinical factors associated with sADT. RESULTS With a median follow-up of 6 years (range 2-15 years), 13 % of men who underwent primary prostatectomy or radiotherapy received sADT. After adjusting for selected covariates, sADT was more likely to be used in men who were older (e.g., HR 1.70, 95 % CI 1.48-1.96 or HR 1.33, 95 % CI 1.17-1.52 for age 70+ relative to age 35-59 for primary prostatectomy or radiotherapy, respectively), were African-American, had a short PSA doubling time, had a higher pre-treatment risk of progression, had more comorbidities, and received adjuvant ADT for initial disease. CONCLUSIONS In men with localized prostate cancer in community practice initially treated with prostatectomy or radiotherapy, sADT after primary treatment was more frequent for men at greater risk of death from prostate cancer, consistent with practice guidelines.
Collapse
|
10
|
Salmasi AH, Patel N, Kim IY. Androgen Deprivation Therapy: Appropriate Patients, Timing to Initiate ADT, and Complications. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
11
|
Potosky AL, Haque R, Cassidy-Bushrow AE, Ulcickas Yood M, Jiang M, Tsai HT, Luta G, Keating NL, Smith MR, Van Den Eeden SK. Effectiveness of primary androgen-deprivation therapy for clinically localized prostate cancer. J Clin Oncol 2014; 32:1324-30. [PMID: 24638009 DOI: 10.1200/jco.2013.52.5782] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Primary androgen-deprivation therapy (PADT) is often used to treat clinically localized prostate cancer, but its effects on cause-specific and overall mortality have not been established. Given the widespread use of PADT and the potential risks of serious adverse effects, accurate mortality data are needed to inform treatment decisions. METHODS We conducted a retrospective cohort study using comprehensive utilization and cancer registry data from three integrated health plans. All men were newly diagnosed with clinically localized prostate cancer. Men who were diagnosed between 1995 and 2008, were not treated with curative intent therapy, and received follow-up through December 2010 were included in the study (n = 15,170). We examined all-cause and prostate cancer-specific mortality as our main outcomes. We used Cox proportional hazards models with and without propensity score analysis. RESULTS Overall, PADT was associated with neither a risk of all-cause mortality (hazard ratio [HR], 1.04; 95% CI, 0.97 to 1.11) nor prostate-cancer-specific mortality (HR, 1.03; 95% CI, 0.89 to 1.19) after adjusting for all sociodemographic and clinical characteristics. PADT was associated with decreased risk of all-cause mortality but not prostate-cancer-specific mortality. PADT was associated with decreased risk of all-cause mortality only among the subgroup of men with a high risk of cancer progression (HR, 0.88; 95% CI, 0.78 to 0.97). CONCLUSION We found no mortality benefit from PADT compared with no PADT for most men with clinically localized prostate cancer who did not receive curative intent therapy. Men with higher-risk disease may derive a small clinical benefit from PADT. Our study provides the best available contemporary evidence on the lack of survival benefit from PADT for most men with clinically localized prostate cancer.
Collapse
Affiliation(s)
- Arnold L Potosky
- Arnold L. Potosky, Huei-Ting Tsai, George Luta, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Reina Haque, Kaiser Permanente Southern California, Pasadena; Stephen K. Van Den Eeden, Kaiser Permanente Northern California, Oakland, CA; Andrea E. Cassidy-Bushrow, Henry Ford Hospital, Detroit, MI; Marianne Ulcickas Yood, Boston University School of Public Health; Nancy L. Keating, Brigham and Women's Hospital and Harvard Medical School; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Miao Jiang, Harvey L. Neiman Health Policy Institute, Reston, VA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Ramírez-Backhaus M, Rubio-Briones J, Collado A, Casanova J, Gómez-Ferrer A, Domínguez J, Ricos J, Monros J, Iborra I, Solsona E. Radical prostatectomy is a reasonable treatment for patients over 70 years of age. Actas Urol Esp 2014; 38:21-7. [PMID: 23648265 DOI: 10.1016/j.acuro.2013.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/17/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the tumor nature and oncological course of patients operated on by radical prostatectomy in three age groups. MATERIAL AND METHOD From the prospective completion of the data base of our department, we analyzed 1012 patients operated on between 1986 and December 2009. Patients with neo- or adjuvant treatment and those with pre-operative PSA over 50 were excluded. The sample was divided into three groups: younger than 60, 60 to 69 and over 70. The clinical, pathological variables, biochemical course and need for rescue treatment were analyzed. We consider biochemical relapse as when the PSA values reached values greater than 0.4 in two consecutive measurements. Rescue was defined as the need for hormone treatment or radiotherapy. We then made a comparative study, a univariate survival analysis by Kaplan and Meyer Curves and multivariate by Cox's regression. RESULTS The median follow-up was 55.1 months. Of the 1012 patients included in the study, 317 patients (31.3%) had biochemical progression and 259 (25.6%) required rescue treatment. We observed that the groups with the older age had a significantly higher PSA and higher stages than the rest. No differences were observed in the Gleason score of the surgical specimen or in the state of the surgical margins. Biochemical relapse free survival at 5 years was 72.3% (CI 66.4-78.2) in patients under 60 years, 65.3% (CI 60.6-70.0) for patients under 70 and 62.2% (CI 53.2-71.1) for patients of 70 years or older; P<.05. In the univariate study, age was a factor that was significantly associated to biochemical relapse. However, it loses interest in the multivariate study and PSA, pathological state and Gleason score regain interest. Rescue treatment free survival did not differ by age groups. CONCLUSIONS In the current study, worse biochemical evolution of patients over 70 was observed. However, this worse biochemical course was conditioned by clinically more aggressive tumors that, in our opinion, justifies the decision made in regards to the surgical approach taken with these patients.
Collapse
|
13
|
|
14
|
Lin YH, Chen CL, Hou CP, Chang PL, Tsui KH. A comparison of androgen deprivation therapy versus surgical castration for patients with advanced prostatic carcinoma. Acta Pharmacol Sin 2011; 32:537-42. [PMID: 21399652 PMCID: PMC4001979 DOI: 10.1038/aps.2010.236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 12/31/2010] [Indexed: 01/03/2023] Open
Abstract
AIM To examine the outcomes of patients with advanced prostate carcinoma who underwent medical or surgical castration. METHODS A hundred twenty one consecutive cases of patients with advanced prostate carcinoma who underwent medical or surgical castration between 2001 and 2006 were retrospectively reviewed. Associations between clinical outcomes and prognostic scoring factors were determined based on the Reijke study. In the surgical and medical castration groups, the impact on the prostate-specific antigen (PSA) normalization rate, the rebound rate and the disease-free survival rate were evaluated. The mean follow-up was 36.1 months. RESULTS In the initial 12 months, there were no statistical differences in the PSA normalization rate and the PSA rebound rate between the two groups. However, the PSA rebound rate after the 12th month (20.90% vs 40.74%, P=0.0175) and the 18th month PSA normalization rate (59.70% vs 37.04%, P=0.0217) differed significantly between the two groups, and these differences were maintained to the end of the study. When comparing patients grouped according to Reijke prognosis scores, there was no difference between medical and surgical castration for the good prognosis group. However, among the patients given a poor prognosis, surgical castration was superior in terms of the PSA normalization rate, the PSA rebound rate, the tumor progression-free survival rate (P<0.001) and the overall survival rate (P<0.001). CONCLUSION Advanced prostate carcinoma patients with poor pretreatment prognosis scores should undergo surgical castration rather than medical castration for better PSA rebound rates and overall survival.
Collapse
Affiliation(s)
- Yu-hsiang Lin
- Department of Urology, Division of Geriatric Urology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Chien-lun Chen
- Department of Urology, Division of Geriatric Urology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, China
- Bioinformation Center, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan, China
| | - Chen-pang Hou
- Department of Urology, Division of Geriatric Urology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Phei-lang Chang
- Department of Urology, Division of Geriatric Urology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, China
- Bioinformation Center, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan, China
| | - Ke-hung Tsui
- Department of Urology, Division of Geriatric Urology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, China
- Bioinformation Center, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan, China
| |
Collapse
|
15
|
Effect of urologists and medical oncologists on treatment of elderly men with Stage IV prostate cancer. Urology 2011; 77:1088-95. [PMID: 21439617 DOI: 10.1016/j.urology.2010.11.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/12/2010] [Accepted: 11/25/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine, among elderly men with incident advanced prostate cancer (PCa), their treatment, in general, and chemotherapy, in particular, in association with a posturologist medical oncologist/hematologist (PUMOH) visit. The role of specialists in the management of advanced PCa is evolving in response to positive chemotherapy trials of PCa. METHODS Linked Surveillance, Epidemiology, and End results and Medicare data included patients with Stage IV PCa diagnosed from 1994 to 2002 who had visited a urologist after the diagnosis and received treatment. The visits and treatment were examined, comparing patients with and without PUMOH visits. RESULTS Most (77%) patients received treatment of their PCa and 85% of treated patients had a subsequent visit with a urologist, of whom 91% saw the urologist first (n = 5435). Of these, 43% saw only the urologist, 41% saw a medical oncologist/hematologist, and 32% saw a radiation oncologist. Of the 5435 patients, 16% received chemotherapy and the adjusted odds of chemotherapy receipt were 7.2 times greater (95% confidence interval 6.0-8.7, P < .001) among those with a PUMOH visit. Compared with non-Hispanic whites, black Americans were less likely (adjusted odds ratio 0.53, P < .001) to receive chemotherapy, although the likelihood of a PUMOH visit was similar (adjusted odds ratio 0.86, P = .14) among the groups. CONCLUSIONS The results of our study have shown that nearly one quarter of men with Stage IV PCa receive no PCa treatment. Although a PUMOH visit is a significant predictor of chemotherapy receipt, many men with advanced PCa received chemotherapy without a medical oncologist/hematologist visit. Black American and elderly men were less likely to receive chemotherapy for advanced PCa.
Collapse
|
16
|
Elliott SP, Jarosek SL, Wilt TJ, Virnig BA. Reduction in physician reimbursement and use of hormone therapy in prostate cancer. J Natl Cancer Inst 2010; 102:1826-34. [PMID: 21131577 DOI: 10.1093/jnci/djq417] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Use of androgen suppression therapy (AST) in prostate cancer increased more than threefold from 1991 to 1999. The 2003 Medicare Modernization Act reduced reimbursements for AST by 64% between 2004 and 2005, but the effect of this large reduction on use of AST is unknown. METHODS A cohort of 72,818 men diagnosed with prostate cancer in 1992-2005 was identified from the Surveillance, Epidemiology, and End Results database. From Medicare claims data, indicated AST was defined as 3 months or more of AST in the first year in men with metastatic disease (n = 8030). Non-indicated AST was defined as AST given without other therapies such as radical prostatectomy or radiation in men with low-risk disease (n = 64,788). The unadjusted annual proportion of men receiving AST was plotted against the median Medicare AST reimbursement. A multivariable model was used to estimate the odds of AST use in men with low-risk and metastatic disease, with the predictor of interest being the calendar year of the payment change. Covariates in the model included age in 5-year categories, clinical tumor stage (T1-T4), World Health Organization grade (1-3, unknown), Charlson comorbidity (0, 1, 2, ≥ 3), race, education, income, and tumor registry site, all as categorical variables. The models included variations in the definition of AST use (≥ 1, ≥ 3, and ≥ 6 months of AST). All statistical tests were two-sided. RESULTS AST use in the low-risk group peaked at 10.2% in 2003, then declined to 7.1% in 2004 and 6.1% in 2005. After adjusting for tumor and demographic covariates, the odds of receiving non-indicated primary AST decreased statistically significantly in 2004 (odds ratio [OR] = 0.70, 95% confidence interval = 0.61 to 0.80) and 2005 (OR = 0.61, 95% confidence interval = 0.53 to 0.71) compared with 2003. AST use in the metastatic disease group was stable at 60% during the payment change, and the adjusted odds ratio of receiving AST in this group was unchanged in 2004-2005. CONCLUSIONS In this example of hormone therapy for prostate cancer, decreased physician reimbursement was associated with a reduction in overtreatment without a reduction in needed services.
Collapse
Affiliation(s)
- Sean P Elliott
- Department of Urologic Surgery, University of Minnesota, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA.
| | | | | | | |
Collapse
|
17
|
Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
DiBlasio CJ, Malcolm JB, Hammett J, Wan JY, Aleman MA, Patterson AL, Wake RW, Derweesh IH. Survival outcomes in men receiving androgen-deprivation therapy as primary or salvage treatment for localized or advanced prostate cancer: 20-year single-centre experience. BJU Int 2009; 104:1208-14. [PMID: 19388987 DOI: 10.1111/j.1464-410x.2009.08593.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the overall survival (OS) and disease-specific survival (DSS) in men receiving primary androgen-deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer. PATIENTS AND METHODS After Institutional Review Board approval, we retrospectively reviewed patients receiving ADT for prostate cancer between July 1987 and June 2007. Variables included age at diagnosis and ADT induction, race, PSA level before ADT, ADT schedule (continuous/intermittent), clinical/pathological stage, hormone-refractory prostate cancer (HRCP) status, PADT or SADT, and deaths. RESULTS In all, 548 men were analysed. The mean age at diagnosis and ADT induction were 70.1 and 72.3 years, respectively, and 321 (58.6%) were African-American. The median PSA level before ADT was 16.3 ng/mL. ADT was administered continuously in 497 (90.7%) patients; 342 (62.4%) received PADT while 206 (37.6%) received SADT. At mean (range) follow-up of 81.8 (2.1-445) months, 98 (17.9%) deaths occurred; 31 (31.6%) were cancer-specific. The OS and DSS in the PADT and SADT groups were not significantly different (P = 0.36 and P = 0.81, respectively). Mortality rates/distributions were similar between groups (P = 0.68). Multivariate predictors of OS and DSS included age at diagnosis (P = 0.03) and ADT induction (P = 0.009), tumour stage (P < 0.001), and PSA level at ADT induction (P = 0.01). Progression to HRPC worsened OS and DSS (both P < 0.001). CONCLUSION PADT and SADT prolong survival in men with prostate cancer. HRPC portends a poor DSS. Age at diagnosis and ADT induction, PSA level before ADT, and disease stage predict both OS and DSS in this population. However, most men died from causes unrelated to prostate cancer, thus questioning the true value of ADT in prolonging patient survival.
Collapse
|