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Parry MG, Nossiter J, Morris M, Sujenthiran A, Skolarus TA, Berry B, Nathan A, Cathcart P, Aggarwal A, van der Meulen J, Trinh QD, Payne H, Clarke NW. Comparison of the treatment of men with prostate cancer between the US and England: an international population-based study. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-021-00482-6. [PMID: 35001083 DOI: 10.1038/s41391-021-00482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The treatment of prostate cancer varies between the United States (US) and England, however this has not been well characterised using recent data. We therefore investigated the extent of the differences between US and English patients with respect to initial treatment. METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database to identify men diagnosed with prostate cancer in the US and the treatments they received. We also used the National Prostate Cancer Audit (NPCA) database for the same purposes among men diagnosed with prostate cancer in England. Next, we used multivariable regression to estimate the adjusted risk ratio (aRR) of receiving radical local treatment for men with non-metastatic prostate cancer according to the country of diagnosis (US vs. England). The five-tiered Cambridge Prognostic Group (CPG) classification was included as an interaction term. RESULTS We identified 109,697 patients from the SEER database, and 74,393 patients from the NPCA database, who were newly diagnosed with non-metastatic prostate cancer between April 1st 2014 and December 31st 2016 with sufficient information for risk stratification according to the CPG classification. Men in the US were more likely to receive radical local treatment across all prognostic groups compared to men in England (% radical treatment US vs. England, CPG1: 38.1% vs. 14.3% - aRR 2.57, 95% CI 2.47-2.68; CPG2: 68.6% vs. 52.6% - aRR 1.27, 95% CI 1.25-1.29; CPG3: 76.7% vs. 67.1% - aRR 1.12, 95% CI 1.10-1.13; CPG4: 82.6% vs. 72.4% - aRR 1.09, 95% CI 1.08-1.10; CPG5: 78.2% vs. 71.7% - aRR 1.06, 95% CI 1.04-1.07) CONCLUSIONS: Treatment rates were higher in the US compared to England raising potential over-treatment concerns for low-risk disease (CPG1) in the US and under-treatment of clinically significant disease (CPG3-5) in England.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Flatiron, London, UK
| | - Ted A Skolarus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arjun Nathan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,University College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
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Photodynamic therapy for prostate cancer: a systematic review and meta-analysis. Prostate Int 2018; 7:83-90. [PMID: 31485431 PMCID: PMC6713795 DOI: 10.1016/j.prnil.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Photodynamic therapy (PDT) is an emerging focal treatment modality for prostate cancer. However, the efficacy, safety, and functional outcomes of PDT are not clear. We performed a meta-analysis of available single-arm studies and control trials which used PDT for prostate cancer. Materials and methods We searched Pubmed, Embase, Ovid and the Cochrane library (until March,2018) for studies about PDT in patients with prostate cancer. The negative biopsy rate after PDT, PSA decreasing rate, pooled rate of functional outcome (IPSS or IIEF-5), and adverse events were analyzed. Results 14 studies containing 654 patients were included. Nine of the 14 included studies had evaluated a negative biopsy rate after PDT. The pooled rate was 55.0% (95.0% CI: 0.44–0.66, I2 = 85.7%). Twelve of the 14 included studies which evaluated PSA decreasing rate with the pooled rate of 35.0% (95.0% CI: 0.24–0.47, I2 = 88.7%). Six of the included studies evaluated IPSS with decreasing rate of 29.1% (95.0 % CI: 2.7%–55.5%, I2 = 96.9%). Five of the included studies evaluated IIEF-5 with decreasing rate of 14.9% (95.0% CI: 6.8%–23.0%, I2 = 44.2%). The most common adverse events were haematuria (28.1%, 95.0% CI: 17.1%–39.2%, I2 = 79.8%), erectile dysfunction (23.1%, 95.0% CI: 9.7%–36.5%, I2 = 87.7%), and dysuria (18.6%, 95.0% CI: 12.1%–25.0 %, I2 = 53.4 %). Conclusions The meta-analysis results shows that PDT for patients with prostate cancer can be considered as effective based on single-arm clinical trials. Meanwhile, this study reveals that there are not only low levels of side effect rates but also insignificant effect on both urinary and erectile function. However, more high-quality RCTs are needed to evaluate the comparative efficacy, safety, and functional outcomes of PDT for patients with prostate cancer.
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Gnanapragasam VJ, Hori S, Johnston T, Smith D, Muir K, Alonzi R, Winkler M, Warren A, Staffurth J, Khoo V, Tree A, Macneill A, McMenemin R, Mason M, Cathcart P, de Souza N, Sooriakumaran P, Weston R, Wylie J, Hall E, Lane A, Cross W, Syndikus I, Koupparis A. Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816651362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.
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Affiliation(s)
| | - S Hori
- Academic Urology Group, University of Cambridge, UK
| | - T Johnston
- Academic Urology Group, University of Cambridge, UK
| | - D Smith
- Prostate Cancer Support Association, UK
| | - K Muir
- Institute of Public Health, University of Manchester, UK
| | - R Alonzi
- Department of Clinical Oncology, Mount Vernon Cancer Centre, UK
| | - M Winkler
- Department of Urology, Charing Cross Hospital, UK
| | - A Warren
- Department of Pathology, Addenbrookes Hospital, UK
| | - J Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | - V Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Tree
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Macneill
- Department of Urology, Western General Hospital, NHS Lothian, UK
| | | | - M Mason
- Institute of Cancer and Genetics, Cardiff University, UK
| | - P Cathcart
- Department of Urology, UCL Hospitals, UK
| | | | | | - R Weston
- Department of Urology, Royal Liverpool University Hospital, UK
| | - J Wylie
- Department of Oncology, Christie Hospital, UK
| | - E Hall
- Clinical Trials and Statistics Unit; Institute of Cancer Research, UK
| | - A Lane
- Department of Social Medicine, University of Bristol, UK
| | - W Cross
- Department of Urology, St. James’s University Hospital, UK
| | - I Syndikus
- Radiotherapy Department, Clatterbridge Cancer Centre, UK
| | - A Koupparis
- Department of Urology, Bristol Urological Institute, UK
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