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Khan S, Fuzzell L, Langston M, Han Y, Moore JX, Gilbert K, Sutcliffe S, Bensen JT, Mohler JL, Fontham ETH, Song L, Lewis-Thames MW. The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer. Cancer Causes Control 2024; 35:531-539. [PMID: 37919455 PMCID: PMC11323108 DOI: 10.1007/s10552-023-01821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort. METHODS The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer. RESULTS Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men. CONCLUSION Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.
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Affiliation(s)
- Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA.
- Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Blvd., 7th floor, Newark, DE, 19713, USA.
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-COEE, Tampa, FL, 33612, USA
| | - Marvin Langston
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA
| | - Justin X Moore
- Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Keon Gilbert
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis, University, 3545 Lafayette Ave., Room 316, St. Louis, MO, 63103, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA
- Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, 4921 Parkview Place, St. Louis, MO, 63110, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, 3130 Bioinformatics Building, CB# 7295, Chapel Hill, NC, 27599, USA
| | - James L Mohler
- Roswell Park Comprehensive Cancer Center, Elm and Carlton St, Buffalo, NY, 14263, USA
| | - Elizabeth T H Fontham
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA
| | - Lixin Song
- School of Nursing, University of North Carolina - Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr, Chicago, IL, 60611, USA
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Han JH, Lee S, Lee B, Baek OK, Washington SL, Herlemann A, Lonergan PE, Carroll PR, Jeong CW, Cooperberg MR. Explainable ML models for a deeper insight on treatment decision for localized prostate cancer. Sci Rep 2023; 13:11532. [PMID: 37460568 DOI: 10.1038/s41598-023-38162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Although there are several decision aids for the treatment of localized prostate cancer (PCa), there are limitations in the consistency and certainty of the information provided. We aimed to better understand the treatment decision process and develop a decision-predicting model considering oncologic, demographic, socioeconomic, and geographic factors. Men newly diagnosed with localized PCa between 2010 and 2015 from the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database were included (n = 255,837). We designed two prediction models: (1) Active surveillance/watchful waiting (AS/WW), radical prostatectomy (RP), and radiation therapy (RT) decision prediction in the entire cohort. (2) Prediction of AS/WW decisions in the low-risk cohort. The discrimination of the model was evaluated using the multiclass area under the curve (AUC). A plausible Shapley additive explanations value was used to explain the model's prediction results. Oncological variables affected the RP decisions most, whereas RT was highly affected by geographic factors. The dependence plot depicted the feature interactions in reaching a treatment decision. The decision predicting model achieved an overall multiclass AUC of 0.77, whereas 0.74 was confirmed for the low-risk model. Using a large population-based real-world database, we unraveled the complex decision-making process and visualized nonlinear feature interactions in localized PCa.
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Affiliation(s)
- Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungyup Lee
- Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Byounghwa Lee
- Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Ock-Kee Baek
- Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Samuel L Washington
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Annika Herlemann
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Urology, St. James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College, Dublin, Ireland
| | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Routine practice data of three cancer entities: Comparison among cancer registry and health insurance data. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:65-72. [PMID: 36804770 DOI: 10.1016/j.zefq.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/12/2022] [Accepted: 01/07/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Claims data and cancer registry data are valuable secondary data sources for addressing health service research questions. This study provides a thorough insight into the comparability of data from health insurance companies and cancer registries in Germany regarding breast, prostate, and lung cancer patients and their treatment. METHODS For this study claims data of the InGef database and data of the Cancer Registry of Rhineland-Palatinate were used to identify patients living in Rhineland-Palatinate with an incident breast, prostate, or lung cancer diagnosis between Jan. 1, 2018 and Dec. 31, 2019. Both datasets were compared for patient and tumour characteristics as well as treatment strategy. For the descriptive analysis of tumour localisation and treatment all patients were followed up for a maximum of two years. RESULTS A total of 1,470 incident cancer cases were identified in the InGef database and 1,694 in the Cancer Registry. Data on sex, age, and tumour localisation matched well for all cancer entities in the cohorts. Data for early UICC stages I+II varied between the cohorts for prostate cancer (84% InGef, 66% Cancer Registry) and lung cancer (29% InGef, 20% Cancer Registry). Larger deviations were found for antihormonal treatment (breast 54% vs. 44%, prostate 32% vs. 18%). Significant differences were found for surgery (breast and lung) and radiation (breast and prostate), respectively. DISCUSSION Age at diagnosis, tumour localisation, and treatment for breast cancer was well documented in both databases. Tumour-specific deviations were observed for tumour localisations (lung cancer), UICC stage (prostate and lung cancer) and treatment options. CONCLUSION Both databases show very good completeness across cancer entities, but at the same time have minor limitations where they could readily complement each other. Individual linkage of claims and registry data could be an important step to improve oncological studies with routine practice data and to overcome the limitations identified.
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Lifestyle and sociodemographic factors associated with treatment choice of clinically localized prostate cancer in an equal access healthcare system. Prostate Cancer Prostatic Dis 2022; 25:593-595. [PMID: 35618798 DOI: 10.1038/s41391-022-00551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/03/2022] [Accepted: 04/27/2022] [Indexed: 11/09/2022]
Abstract
Sociodemographic and lifestyle factors may play a role in determining whether patients with clinically localized prostate cancer (PC) are managed with active surveillance (AS), radical prostatectomy (RP), or radiation therapy (RT); however, these relationships have not been well examined. In a cross-sectional study conducted within an equal access healthcare system, multivariable adjusted regression analysis revealed that living with a spouse or partner was associated with a 65% lower chance of being managed by RT (P = 0.001) and 57% lower risk of being managed by AS (P = 0.042) compared with RP. No other sociodemographic or lifestyle factors were independently associated with treatment modality.
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A Mutated Prostatic Acid Phosphatase (PAP) Peptide-Based Vaccine Induces PAP-Specific CD8 + T Cells with Ex Vivo Cytotoxic Capacities in HHDII/DR1 Transgenic Mice. Cancers (Basel) 2022; 14:cancers14081970. [PMID: 35454873 PMCID: PMC9032647 DOI: 10.3390/cancers14081970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current treatments for castrate (hormone)-resistant prostate cancer (CRPC) remain limited and are not curative, with a median survival from diagnosis of 23 months. The PAP-specific Sipuleucel-T vaccine, which was approved by the FDA in 2010, increases the Overall Survival (OS) by 4 months, but is extremely expensive. We have previously shown that a 15 amino accid (AA) PAP sequence-derived peptide could induce strong immune responses and delay the growth of murine TRAMP-C1 prostate tumors. We have now substituted one amino acid and elongated the sequence to include epitopes predicted to bind to several additional HLA haplotypes. Herein, we present the immunological properties of this 42mer-mutated PAP-derived sequence (MutPAP42mer). METHODS The presence of PAP-135-143 epitope-specific CD8+ T cells in the blood of patients with prostate cancer (PCa) was assessed by flow cytometry using Dextramer™ technology. HHDII/DR1 transgenic mice were immunized with mutated and non-mutated PAP-derived 42mer peptides in the presence of CAF®09 or CpG ODN1826 (TLR-9 agonist) adjuvants. Vaccine-induced immune responses were measured by assessing the proportion and functionality of splenic PAP-specific T cells in vitro. RESULTS PAP-135-143 epitope-specific CD8+ T cells were detected in the blood of patients with PCa and stimulation of PBMCs from patients with PCa with mutPAP42mer enhanced their capacity to kill human LNCaP PCa target cells expressing PAP. The MutPAP42mer peptide was significantly more immunogenic in HHDII/DR1 mice than the wild type sequence, and immunogenicity was further enhanced when combined with the CAF®09 adjuvant. The vaccine induced secretory (IFNγ and TNFα) and cytotoxic CD8+ T cells and effector memory splenic T cells. CONCLUSIONS The periphery of patients with PCa exhibits immune responsiveness to the MutPAP42mer peptide and immunization of mice induces/expands T cell-driven, wild-type PAP immunity, and therefore, has the potential to drive protective anti-tumor immunity in patients with PCa.
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Büchser D, Medina R, Mayrata E, González A, Marban M, Achard V, Alongi F, Gomez-Iturriaga A, Couñago F. Salvage local treatment for localized radio-recurrent prostate cancer: a narrative review and future perspectives. Future Oncol 2021; 17:4207-4219. [PMID: 34448402 DOI: 10.2217/fon-2021-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although dose escalation protocols have improved biochemical control in prostate cancer radiotherapy, 10-45% of patients will experience disease recurrence. The prostate and seminal vesicles are the most frequent site of the first relapse. Traditionally, these patients have been managed with hormonal therapy, which is not curative. Recent improvements in diagnostic tests (e.g., multiparametric magnetic resonance and molecular imaging, including PET/CT scan with choline or Ga-PSMA) and new treatment techniques (e.g., stereotactic body radiation therapy or other minimally invasive alternatives like high-intensity focus ultrasound, cryoablation or high-dose-rate brachytherapy) offer new therapeutic strategies with the potential to cure some patients with limited adverse effects. In this narrative review, the authors present the most recent evidence to help identify the most suitable candidates for salvage treatment.
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Affiliation(s)
- David Büchser
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Rafael Medina
- Urology, Virgen del Rocio University Hospital, Sevilla 41013, Spain
| | - Esther Mayrata
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Alba González
- Radiation Oncology, Basurto University Hospital, Bilbao 48013, Spain.,Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Marina Marban
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva 1205, Switzerland
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Felipe Couñago
- Radiation Oncology, Quirón Salud University Hospital, Madrid 28223, Spain.,Radiation Oncology, La Luz Hospital, Madrid 28003, Spain.,Clinical Department, Universidad Europea de Madrid, Madrid 28670, Spain
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Olver IN. Prostate cancer treatment in private and public health services. Med J Aust 2020; 213:408-409. [DOI: 10.5694/mja2.50819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Systemic Management for Nonmetastatic Castration-resistant Prostate Cancer: A Systematic Review and Network Meta-Analysis. Am J Clin Oncol 2020; 43:288-297. [PMID: 31972568 DOI: 10.1097/coc.0000000000000660] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To indirectly compare the efficacy and safety of systemic therapies used for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). METHODS The relevant randomized controlled trials were retrieved from PubMed and the Cochrane Library. Network meta-analyses were used to compare multiple drugs simultaneously for the outcomes of nmCRPC. Direct evidence in trials and indirect evidence across trials were combined by the network meta-analyses to estimate the treatment efficiency. OUTCOME Eight studies were included in our research. For prostate-specific antigen progression-free survival, the rate of progression was significantly decreased following apalutamide, enzalutamide, bicalutamide+dutasteride, and bicalutamide treatment compared with placebo. Compared with placebo treatment, metastases-free survival was significantly increased in patients who received apalutamide (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.23-0.35), enzalutamide (HR: 0.29, 95% CI: 0.24-0.35), and darolutamide (HR: 0.42, 95% CI: 0.35-0.50). Direct comparison showed significant survival benefits in patients who received second-generation anti-androgen therapy (apalutamide, enzalutamide, and darolutamide: HR: 0.74, 95% CI: 0.61-0.91) compared with patients who received placebo. With respect to metastases-free survival, based on SUCRA analysis, there was 80% and 78% probability that apalutamide and enzalutamide were preferred treatment, while darolutamide was likely to be second-best choice. Compared with placebo, all agents were not associated with significantly higher likelihood of serious adverse events and grade 3 to 4 adverse events. CONCLUSION Our outcomes support equivalent efficacy and similar risk of adverse effects between apalutamide, enzalutamide, and darolutamide, supporting the use of these antiandrogen agents in high-risk of progression nmCRPC.
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Outcomes for Young Men With Localized Intermediate-Risk Prostate Cancer: An Analysis of the NCDB. Clin Genitourin Cancer 2020; 18:e531-e542. [PMID: 32220567 DOI: 10.1016/j.clgc.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/24/2020] [Accepted: 02/02/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary management of localized, intermediate-risk prostate cancer consists of radical prostatectomy (RP), radiotherapy (RT) with short-course androgen deprivation therapy (ADT), or RT alone. The purpose of this study was to determine if these treatment strategies have equivalent overall survival (OS) in patients < 55 years old with intermediate-risk prostate cancer. PATIENTS AND METHODS We identified 35,134 patients in the National Cancer Data Base with localized intermediate-risk prostate cancer treated with RP, RT + ADT, or RT from 2004 to 2013. Ten-year OS rates were estimated by the Kaplan-Meier method. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed by multivariate Cox regression. RESULTS A total of 29,920 patients (85.2%) underwent RP, 1393 (4.0%) RT + ADT, and 3821 (10.9%) RT. Median patient age was 51 years old, and median follow-up was 59.9 months. Ten-year OS was estimated to be 94.2% for RP, 80.7% for RT + ADT, and 85.2% for RT (P < .0001). On multivariate analysis, treatment with RT + ADT or RT was associated with significantly worse OS compared to treatment with RP (RT + ADT HR = 2.06, 95% CI 1.67-2.54, P < .0001; RT HR = 2.0, 95% CI 1.71-2.33, P < .0001). Patients who met all 3 of the intermediate-risk criteria showed worse OS compared to patients who met only one criterion (HR = 1.80; 95% CI, 1.32-2.44; P = .0002). CONCLUSION RP is significantly more likely than RT + ADT or RT to be used as a primary treatment for young men with localized intermediate prostate cancer. RP was also associated with improved OS compared to RT + ADT and RT.
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Survival and prognostic determinants of prostate cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A retrospective cohort study. PLoS One 2020; 15:e0229854. [PMID: 32134996 PMCID: PMC7058322 DOI: 10.1371/journal.pone.0229854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Globally, the incidence of prostate cancer is increasing, particularly in low- and middle-income countries. It is the most common cancer among men worldwide, with higher mortality in low and middle-income countries. In Ethiopia, it is the second most common cause of cancer morbidity and mortality among men. Despite a few studies done regarding the disease burden, the evidence is scarce about the survival and prognostic determinants of prostate cancer patients in Ethiopia. Thus, this study assessed the survival and prognostic determinants of patients with prostate cancer. Methods We retrospectively followed patients who were newly diagnosed from 2012 to 2016 at the Oncology Department of Tikur Anbessa Specialized Hospital. We extracted the data from patient charts that were available in the cancer registry using a checklist with the help of oncology nurses. Kaplan-Meier survival analyses with the log-rank test were used to estimate and compare the probability of survival among covariate categories. After checking for assumptions, a multivariable Cox regression analysis was performed to identify prognostic determinants of survival. Results The median survival time was 28 months with an overall 2-, 3- and 5-year survival of 57%, 38.9% and 22%, respectively. The overall survival differs according to the clinical stage (P-value<0.01), presence or absence of distant metastasis (P<0.01) and androgen deprivation therapy (ADT) (P<0.05). Cancer stage at diagnosis (adjusted hazard ratio (AHR) = 0.309, 95%CI = 0.151–0.633) and ADT (AHR = 3.884, 95%CI = 1.677–8.997) remained significant in the final Cox proportional hazards model. Conclusions The overall 2-, 3- and 5-year survival of prostate cancer patients in Ethiopia is very low. The cancer stage at diagnosis and treatment modalities are significant prognostic determinants of survival. Therefore, early detection through screening and timely initiation of treatment are essential to improve the survival of prostate cancer patients.
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Patel GK, Chugh N, Tripathi M. Neuroendocrine Differentiation of Prostate Cancer-An Intriguing Example of Tumor Evolution at Play. Cancers (Basel) 2019; 11:E1405. [PMID: 31547070 PMCID: PMC6826557 DOI: 10.3390/cancers11101405] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023] Open
Abstract
Our understanding of neuroendocrine prostate cancer (NEPC) has assumed a new perspective in light of the recent advances in research. Although classical NEPC is rarely seen in the clinic, focal neuroendocrine trans-differentiation of prostate adenocarcinoma occurs in about 30% of advanced prostate cancer (PCa) cases, and represents a therapeutic challenge. Even though our knowledge of the mechanisms that mediate neuroendocrine differentiation (NED) is still evolving, the role of androgen deprivation therapy (ADT) as a key driver of this phenomenon is increasingly becoming evident. In this review, we discuss the molecular, cellular, and therapeutic mediators of NED, and emphasize the role of the tumor microenvironment (TME) in orchestrating the phenotype. Understanding the role of the TME in mediating NED could provide us with valuable insights into the plasticity associated with the phenotype, and reveal potential therapeutic targets against this aggressive form of PCa.
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Affiliation(s)
- Girijesh Kumar Patel
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
| | - Natasha Chugh
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
| | - Manisha Tripathi
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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Sacramento RS, Simião LDJ, Viana KCG, Andrade MAC, Amorim MHC, Zandonade E. Associação de variáveis sociodemográficas e clínicas com os tempos para início do tratamento do câncer de próstata. CIENCIA & SAUDE COLETIVA 2019; 24:3265-3274. [DOI: 10.1590/1413-81232018249.31142017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/02/2018] [Indexed: 12/31/2022] Open
Abstract
Resumo Disparidades na atenção ao câncer de próstata têm sido reveladas e associadas a fatores sociodemográficos e clínicos, os quais determinam os tempos para diagnóstico e início do tratamento. O objetivo deste artigo é avaliar a associação de variáveis sociodemográficas e clínicas com os tempos para o início do tratamento do câncer de próstata. Estudo de coorte longitudinal prospectivo utilizando dados secundários, cuja população é de homens com câncer de próstata atendidos nos períodos de 2010-2011 e 2013-2014 no Hospital Santa Rita de Cássia, Vitória, Espírito Santo, Brasil. A população do estudo foi de 1.388 homens, do total, os com idade inferior a 70 anos (OR = 1,85; IC = 1,49-2,31), não brancos (OR = 1,30; IC = 1,00-1,70), com menos de oito anos de estudo (OR = 1,52; IC = 1,06-2,17) e encaminhados pelos serviços do Sistema Único de Saúde (OR = 2,52; IC = 1,84-3,46) apresentaram maior risco de atraso no tratamento. Da mesma forma, quanto menor o escore de Gleason (OR = 1,78; IC = 1,37-2,32) e os níveis de Antígeno Prostático Específico (OR = 2,71; IC = 2,07-3,54) maior a probabilidade de atraso para iniciar o tratamento. Portanto, as características sociodemográficas e clínicas exerceram uma forte influência no acesso ao tratamento do câncer de próstata.
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Ha US, Choi JB, Shim JI, Kang M, Park E, Kang S, Park J, Yang J, Choi I, Ahn J, Kwak C, Jeong CW, Kim CS, Byun SS, Seo SI, Lee HM, Lee SJ, Lee SH, Chung BH, Lee JY. Is Primary Androgen Deprivation Therapy a Suitable Option for Asian Patients With Prostate Cancer Compared With Radical Prostatectomy? J Natl Compr Canc Netw 2019; 17:441-449. [PMID: 31085754 DOI: 10.6004/jnccn.2018.7265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND We conducted a comparative survival analysis between primary androgen deprivation therapy (PADT) and radical prostatectomy (RP) based on nationwide Korean population data that included all patients with prostate cancer. MATERIALS AND METHODS This study enrolled 4,538 patients with prostate cancer from the National Health Insurance Service (NHIS) database linked with Korean Central Cancer Registry data who were treated with PADT or RP between January 1, 2007, and December 31, 2014. Kaplan-Meier and multivariate survival analyses stratified by stage (localized and locally advanced) and age (<75 and ≥75 years) were performed using a Cox proportional hazards model to evaluate treatment effects. RESULTS Among 18,403 patients from the NHIS database diagnosed with prostate cancer during the study period, 4,538 satisfied inclusion criteria and were included in the analyses. Of these, 3,136 and 1,402 patients underwent RP or received PADT, respectively. Risk of death was significantly increased for patients who received PADT compared with those who underwent RP in the propensity score-matched cohort. In subgroup analyses stratified by stage and age, in every subgroup, patients who received PADT had a significantly increased risk of death compared with those who underwent RP. In particular, a much greater risk was observed for patients with locally advanced prostate cancer. CONCLUSIONS Based on a nationwide survival analysis of nonmetastatic prostate cancer, this study provides valuable clinical implications that favor RP over PDAT for treatment of Asian populations. However, the possibility that survival differences have been overestimated due to not accounting for potential confounding characteristics must be considered.
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Affiliation(s)
- U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, Seoul.,The Cancer Research Institute, The Catholic University of Korea, Seoul
| | - Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon
| | - Jung Im Shim
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Minjoo Kang
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Eunjung Park
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Shinhee Kang
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Jooyeon Park
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Jangmi Yang
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Insun Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul
| | - Choung Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon; and
| | - Seung Hwan Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, Seoul.,The Cancer Research Institute, The Catholic University of Korea, Seoul.,National Evidence-based Healthcare Collaborating Agency, Seoul
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14
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Khullar K, Parikh RR. The role of radiotherapy in metastatic prostate cancer. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2019; 7:92-97. [PMID: 31139704 PMCID: PMC6526359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
The current standard of care for patients with metastatic prostate cancer includes ADT with a palliative intent. Recent studies have investigated the role of local therapy in metastatic prostate cancer. While retrospective data has shown some benefit with regard to survival and delay in initiation of ADT, there has been limited prospective Randomized data. To date, there has only been one recent randomized trial revealing a survival benefit with local radiotherapy, largely benefiting patients with the lowest burden of disease. The purpose of this review is to summarize the evidence and ongoing clinical trials regarding the role of radiotherapy in metastatic prostate cancer patients.
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Affiliation(s)
- Karishma Khullar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey New Brunswick, NJ, USA
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey New Brunswick, NJ, USA
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15
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Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
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16
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Shah S, Young HN, Cobran EK. An economic evaluation of conservative management and cryotherapy in patients with localized prostate cancer. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Surbhi Shah
- Division of Pharmaceutical Health Services, Outcomes, and Policy; College of Pharmacy; University of Georgia; Athens GA USA
| | - Henry N. Young
- Division of Pharmaceutical Health Services, Outcomes, and Policy; College of Pharmacy; University of Georgia; Athens GA USA
| | - Ewan K. Cobran
- Division of Pharmaceutical Health Services, Outcomes, and Policy; College of Pharmacy; University of Georgia; Athens GA USA
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17
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Shah S, Young HN, Cobran EK. Comparative Effectiveness of Conservative Management Compared to Cryotherapy in Localized Prostate Cancer Patients. Am J Mens Health 2018; 12:1681-1691. [PMID: 29877137 PMCID: PMC6142136 DOI: 10.1177/1557988318781731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The high frequency of treatment-related side effects for men with localized prostate cancer creates uncertainty for treatment outcomes. This study assessed the comparative effectiveness of treatment-related side effects associated with conservative management and cryotherapy in patients with localized prostate cancer. A retrospective longitudinal cohort study was conducted, using the linked data of the Surveillance, Epidemiology, and End Results and Medicare, which included patients diagnosed from 2000 through year 2013, and their Medicare claims information from 2000 through 2014. To compare the differences in baseline characteristics and treatment-related side effects between the study cohorts, χ2 tests were conducted. Multivariate logistic regression was used to assess the association between treatment selection and side effects. There were 7,998 and 3,051 patients in the conservative management and cryotherapy cohort, respectively. The likelihood of erectile dysfunction, lower urinary tract obstruction, urinary fistula, urinary incontinence, and hydronephrosis was reported to be significantly lower (53%, 35%, 69%, 65%, and 36%, respectively) in the conservative management cohort. Conservative management had a lower likelihood of treatment-related side effects compared to cryotherapy. However, further research is needed to compare other significant long-term outcomes such as costs associated with these treatment choices and quality of life.
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Affiliation(s)
- Surbhi Shah
- 1 Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Henry N Young
- 1 Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Ewan K Cobran
- 1 Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, College of Pharmacy, University of Georgia, Athens, GA, USA
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18
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Zhao F, Shen J, Yuan Z, Yu X, Jiang P, Zhong B, Xiang J, Ren G, Xie L, Yan S. Trends in Treatment for Prostate Cancer in China: Preliminary Patterns of Care Study in a Single Institution. J Cancer 2018; 9:1797-1803. [PMID: 29805706 PMCID: PMC5968768 DOI: 10.7150/jca.25113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/13/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives: A Patterns of Care Study (PCS) was performed in the largest regional medical center in Zhejiang Province, China. The hospital information system (HIS) was used to evaluate patient characteristics and changes in initial treatment patterns for prostate cancer and to determine recent predominant trends in treatment plans for prostate cancer (PCa) in China. Methods: Men who were newly diagnosed with localized or locally advanced PCa for 2010-2011 and 2016-2017 were identified in the HIS database. Patient characteristics and temporal trends in initial management were assessed, and differences between groups were evaluated for significance using Chi-square and Mann-Whitney U tests. Results: In total, 1792 patients met the study criteria, including 505 and 1287 patients in the 2010-2011 and 2016-2017 samples, respectively. The average age of patients diagnosed in the 2010-2011 PCS survey was 70 years, decreasing to 68 years when the 2016-2017 patients were included (P<0.001). In the 2010-2011 sample, 50.69% of the patients had an initial prostate-specific antigen (PSA) level ≥20 ng/ml. In contrast, the initial PSA level was 4-19.99 ng/ml for 66.67% of the patients in the 2016-2017 sample (P<0.001). Based on National Comprehensive Cancer Network (NCCN) criteria, the percentages of patients in low- and intermediate-risk groups increased from 33.06% to 54.78%; conversely, the percentages in high-risk, very high-risk, and regional (N1) groups decreased to a certain extent (P<0.001). According to European Association of Urology (EAU) criteria, the percentages of patients in low- and intermediate-risk groups increased from 32.07% to 53.69%, yet the percentage in the high-risk group decreased (P<0.001). The use of radical prostatectomy (RP) and radiation therapy (RT) increased from 48.32% to 76.46% and 5.35% to 16.94%, particularly in high-risk and low-risk groups, respectively, whereas the rates of hormone therapy (HT) and active surveillance and observation (AS&O) decreased from 32.28% to 4.27% and from 16.04% to 2.33%, respectively (P<0.001). A similar pattern was observed when patients were stratified by EAU risk group. Conclusions: The results of this real-world study in the largest regional medical center in Zhejiang Province, China, indicate that the predominant characteristics of PCa patients and trends in initial management are changing rapidly. We found the following: (a) a trend toward a decreased age among newly diagnosed patients; (b) a trend toward lower initial PSA levels; (c) a downward trend in risk group classification; (d) a significant increase in the likelihood of receiving RP, particularly in the high-risk group; (e) an increase in the rate of RP, mostly due to use of the Da Vinci robotic system; (f) a significant increase in the likelihood of receiving RT, especially in the low-risk group; and (g) a decrease in HT and AS&O.
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Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jiayan Shen
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zuguo Yuan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Xiaokai Yu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Peng Jiang
- Department of Urology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Baishu Zhong
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jianjian Xiang
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Guoping Ren
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Liping Xie
- Department of Urology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Senxiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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19
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Golbari NM, Katz AE. Salvage Therapy Options for Local Prostate Cancer Recurrence After Primary Radiotherapy: a Literature Review. Curr Urol Rep 2018; 18:63. [PMID: 28688020 DOI: 10.1007/s11934-017-0709-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW While recurrence after primary treatment of prostate cancer (PCa) is not uncommon, there is currently no consensus on the most appropriate management after radiation treatment failure. This article seeks to explore the currently utilized modalities for salvage treatment for radiorecurrent PCa. We focused our review on the oncologic outcomes and reported toxicity rates in the latest studies examining salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage high-intensity focused ultrasound (HIFU) and re-irradiation. RECENT FINDINGS There does not appear to be any significant difference in overall survival for more invasive salvage radical prostatectomy compared to the minimally invasive salvage approaches. Additionally, there seems to be a trend towards lower morbidity rates associated with minimally invasive and focal salvage treatment. We are encouraged by the results presented in this review and find that there is clearly a role for emerging minimally invasive and focal therapies as durable options for salvage treatment in patients with radiorecurrent PCa.
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20
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Buergy D, Sertdemir M, Weidner A, Shelan M, Lohr F, Wenz F, Schoenberg SO, Attenberger UI. Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning? In Vivo 2018; 32:125-131. [PMID: 29275309 PMCID: PMC5892648 DOI: 10.21873/invivo.11214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Salvage radiotherapy improves biochemical control in patients with recurrence of prostate cancer after prostatectomy. Radiotherapy target volumes of the prostatic fossa are based on empirical data and differ between different guidelines. Localization of recurrence with multiparametric magnetic resonance imaging (MRI) might be a feasible approach to localize recurrent lesions. PATIENTS AND METHODS Twenty-one patients with biochemical recurrence after radical prostatectomy were included (median prostate-specific antigen (PSA) =0.17 ng/ml). Multi-parametric MRI was performed using a 3-T MR system. RESULTS Lesions were detected in seven patients with a median PSA of 0.86 ng/ml (minimum= 0.31 ng/ml). Patients without detectable recurrence had a median PSA of 0.12 ng/ml. All patients with detectable lesions responded to radiotherapy. Eleven out of 14 patients without detectable recurrence also responded. Plasma flow in suspicious lesions was correlated with PSA level. CONCLUSION Detection of recurrence at the prostatic fossa with our approach was possible in a minority of patients with a low PSA level. Clinical relevance of plasma flow in suspicious lesions should be further investigated.
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Affiliation(s)
- Daniel Buergy
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Metin Sertdemir
- Medical Care Center Radiology Karlsruhe West, Karlsruhe, Germany
| | - Anja Weidner
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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21
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Tsai HT, Philips G, Taylor KL, Kowalczyk K, Huai-Ching K, Potosky AL. Utilization and predictors of expectant management among elderly men with low-and intermediate-risk localized prostate cancer in U.S. urological practice. UROLOGY PRACTICE 2017; 4:132-139. [PMID: 28808670 DOI: 10.1016/j.urpr.2016.05.005] [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] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Expectant management (EM) reduces overtreatment in low-risk but not intermediate-risk localized prostate cancer (PCa). We assessed the use and predictors of EM to understand its uptake in U.S. practice. METHODS Using the U.S. SEER-Medicare database, we conducted a retrospective cohort study of men 66 years and older diagnosed with low-risk (N=25,506) or intermediate-risk (N=25,597) localized PCa between 2004 - 2011 and followed through December 31, 2012. We defined EM as no definitive therapy (DT) and at least one prostate-specific antigen (PSA) test or re-biopsy 4 - 12 months post diagnosis; or receiving DT after PSA testing or re-biopsy 7 - 12 months after diagnosis. We performed separate analyses for low-risk and intermediate-risk groups using multiple logistic regressions. RESULTS For men diagnosed with PCa in 2004-2011, EM increased from 22% to 43% in the low-risk group and from 15% to 18% in the intermediate-risk group. In the low-risk group, EM increased with patients' age (adjusted odds ratio [aOR] = 1.26 for 71-75 years; 2.21 for 76-80 years; 6.33 for older then 80, p<0.0001, compared to 66-70 years). EM uptake was higher among men with comorbidities (aOR=1.29), and residing in the Pacific region (aOR=0.56, compared to the East Coast). CONCLUSIONS In U.S. practice, the utilization of EM steadily increased in low-risk PCa and remained low in the intermediate-risk group over time. While patients with advanced age or comorbidities were more likely to receive EM, its use varied substantially by geographic region. Our findings bring attention to the presence of multiple barriers for EM implementation.
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Affiliation(s)
- Huei-Ting Tsai
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington D.C., USA
| | - George Philips
- Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington D.C., USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington D.C., USA
| | - Keith Kowalczyk
- Department of Urology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007 USA
| | - Kuo Huai-Ching
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington D.C., USA
| | - Arnold L Potosky
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington D.C., USA
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22
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des Bordes JKA, Lopez DS, Swartz MD, Volk RJ. Sociodemographic Disparities in Cure-Intended Treatment in Localized Prostate Cancer. J Racial Ethn Health Disparities 2017; 5:104-110. [PMID: 28205153 DOI: 10.1007/s40615-017-0348-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/25/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Disparities in prostate cancer (PCa) morbidity and mortality occur across various populations. We investigated the sociodemographic correlates of treatment and disparities in the application of cure-intended (i.e., radical prostatectomy [RP], radiation therapy [RT]) treatment strategies in localized PCa among Texas residents diagnosed with PCa. METHODS We analyzed data from the Texas Cancer Registry on men diagnosed with stage T1 or T2 PCa between 2004 and 2009. Multinomial logistic regression analysis was used to explore independent associations between cure-intended treatment modalities and sociodemographic characteristics (age, race/ethnicity, socioeconomic status [SES], and geographic location (rural versus urban)) using patients who did not receive definitive treatment as comparison group. RESULTS Of 46,971 patients with available treatment data, age-adjusted treatment rates were 39.1% RP, 30.7% RT, and 30.2% for all other non-curative modalities. Compared to patients under 60 years, those ≥60 were less likely to receive RP, patients between 60 and 80 years were more likely to undergo RT, while those 80 years or older were less likely. Non-Hispanic blacks (OR =0.55, 95% CI, 0.50-0.59) and Hispanics (OR = 0.68, 95%CI, 0.62-0.74) were less likely to receive RP compared with whites. Hispanics were significantly less likely to receive RT (OR = 0.78, 95%CI, 0.72-0.85) than blacks and whites. People of low SES were 35% (OR = 0.65, 95%CI, 0.60-0.69) and 15% (OR = 0.85, 95%CI, 0.79-0.90) less likely to receive RP and RT, respectively, compared with those of high SES. Rural-urban status was not associated with cure-intended treatment. CONCLUSION Potential sociodemographic disparities exist in the application of cure-intended treatment in localized prostate cancer in Texas particularly in race/ethnicity and SES.
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Affiliation(s)
- Jude K A des Bordes
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Unit 1465, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - David S Lopez
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA.,Division of Urology, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics, The University of Texas School of Public Health, Houston, TX, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Naik G, Akinyemiju T. Disparities in hospitalization outcomes among African-American and White prostate cancer patients. Cancer Epidemiol 2017; 46:73-79. [PMID: 28056390 DOI: 10.1016/j.canep.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This paper aims to determine whether racial disparities exist in hospitalization outcomes among African-American and White hospitalized prostate cancer patients in the United States. We evaluated racial differences among matched groups of patients in post-operative complications, hospital length of stay and in-hospital mortality. METHODS We identified a total of 183,856 men aged 40 years and older with a primary diagnosis of prostate cancer, of which 58,701 underwent prostatectomy, through the Nationwide Inpatient Sample, and matched all African-American patients with White patients on: 1) Demographics, 2) Demographics+Clinical presentation and 3) Demographics+Clinical presentation+Treatment. Multivariable regression analyses were conducted in SAS and estimates were reported with 95% confidence intervals. RESULTS African-American patients were more likely to be admitted with metastatic disease (24.8%) compared with White patients matched on demographics (17.9%), and demographics+presentation (23.6%). However, 23.9% of African-American patients received surgery compared with 38.2% and 34.2% of Whites matched on demographics and demographics+presentation, respectively. White patients had lower in-hospital mortality compared with African-American patients matched on demographics (OR: 0.72, 95% CI: 0.66-0.79), demographics+presentation (OR: 0.88, 95% CI: 0.81-0.96), but was no longer significantly lower when matched on demographics, presentation and treatment (OR: 0.92, 95% CI: 0.85-1.00). CONCLUSION There were significant racial differences in outcomes among prostate cancer patients within the inpatient setting, even after accounting for demographic and presentation differences.
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Affiliation(s)
- Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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24
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Holmes JA, Bensen JT, Mohler JL, Song L, Mishel MH, Chen RC. Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort. Cancer 2016; 123:138-143. [DOI: 10.1002/cncr.30315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan A. Holmes
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
| | - James L. Mohler
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Department of Urology; Roswell Park Cancer Institute; Buffalo New York
| | - Lixin Song
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Merle H. Mishel
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Sheps Center for Health Services Research; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Raval AD, Madhavan S, Mattes MD, Sambamoorthi U. Types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer. Int J Clin Pract 2016; 70:606-18. [PMID: 27291866 PMCID: PMC4927389 DOI: 10.1111/ijcp.12838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To examine the association between types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer. METHODS A population-based retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. The study cohort consisted of elderly men (≥ 66 years) with localised prostate cancer diagnosed between 2002 and 2009 (N = 98,264). The initial cancer treatment received during the 6 months after cancer diagnosis consisted of (i) radical prostatectomy (RP); (ii) radiation therapy (RT); (iii) hormone therapy; and (iv) no treatment. Pre-existing chronic conditions were classified into the following eight groups: (i) only cardiometabolic conditions (CM); (ii) only mental health conditions (MH); (iii) only respiratory conditions (RESP); (iv) CM and MH; (v) CM and RESP; (vi) MH and RESP; (vii) all three conditions, CM, MH and RESP; and (viii) none of the three types of conditions. RESULTS Only 20% did not receive any cancer treatment; 47.4%, 22.1% and 10.5% received RT, RP, and hormone therapy, respectively. In multinomial logistic regression, elderly men with only RESP were more likely to receive RP as compared with those with all the three types of chronic conditions; those with only CM, only RESP, CM and MH or CM and RESP were more likely to receive RT. No significant associations were observed between the receipt of hormone therapy and types of chronic conditions. CONCLUSIONS A significant proportion of elderly men with chronic conditions have received aggressive initial cancer treatment. Our study findings suggest a conservative approach for the initial prostate cancer treatment among elderly men with significant chronic conditions and localised prostate cancer.
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Affiliation(s)
- A D Raval
- Healthcore Inc., Wilmington, DE, USA
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - S Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - M D Mattes
- Department of Radiation Oncology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - U Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Maurice MJ, Zhu H, Abouassaly R. A hospital-based study of initial observation for low-risk prostate cancer and its predictors in the United States. Can Urol Assoc J 2016; 9:E193-9. [PMID: 26770290 DOI: 10.5489/cuaj.2606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Initial observation (IO) is a strategy to minimize prostate cancer overtreatment. We sought to evaluate contemporary trends in IO utilization for low-risk prostate cancer in the United States and to identify factors associated with its uptake. METHODS Using the National Cancer Database, we identified men with low-risk prostate cancer diagnosed between 2004 and 2011. IO utilization was plotted over time. Multivariate logistic regression was performed to determine the influence of diagnosis year and other factors on IO selection. RESULTS Of the 219 971 men with low-risk prostate cancer, 21 231 (9.7%) underwent IO. Beginning in 2008, IO use increased significantly with time (range: 7.5%-14.3%). Compared to 2004, patients diagnosed in 2011 had 2.5 times the odds of choosing IO (odds ratio [OR] 2.5, confidence interval [CI] 2.3-2.6, p < 0.01). Aside from diagnosis year, age, race, Charlson score, clinical T stage, and PSA level predicted IO use (p < 0.01). Other predictors of IO included hospital type, insurance provider, and household income. Specifically, comprehensive cancer centres, private insurance, and higher income predicted decreased IO usage (OR 0.5, CI 0.5-0.5, p < 0.01; OR 0.4, CI 0.4-0.4, p < 0.01; and OR 0.8, CI 0.8-0.9, p < 0.01, respectively). Less educated men were also less likely to undergo observation (OR 0.8, CI 0.8-0.9, p < 0.01). Treatment within the western United States was significantly, but weakly, associated with increased use of IO (p < 0.01). CONCLUSIONS In recent years, low-risk prostate cancer has been increasingly managed with IO, appropriately driven by patient and disease factors. Unexpectedly, observation usage also varies by race, hospital, insurance, income, and geography, suggesting that non-clinical factors may affect treatment selection.
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Affiliation(s)
| | - Hui Zhu
- Louis Stokes Cleveland VA Medical Center and Cleveland Clinic South Pointe Hospital, Cleveland, OH
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Moul JW. Population Screening for Prostate Cancer and Early Detection. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00001-3] [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
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Wong AT, Safdieh JJ, Rineer J, Weiner J, Schwartz D, Schreiber D. A population-based analysis of contemporary patterns of care in younger men (<60 years old) with localized prostate cancer. Int Urol Nephrol 2015; 47:1629-34. [PMID: 26329748 DOI: 10.1007/s11255-015-1096-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze patterns of care in younger patients (<60 years old) with localized prostate cancer and to identify factors associated with selection of therapy using a large, population-based database. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify men <60 years old diagnosed with localized prostate cancer between 2010 and 2011. Patients were determined to have undergone no active treatment, local therapy, radiation therapy (RT), or radical prostatectomy (RP). Univariate and multivariate logistic regression analyses were performed to identify factors associated with the use of definitive therapy. RESULTS A total of 12,732 men were included in this analysis. For the entire cohort, 12.5 % received no definitive treatment, 61.6 % RP, 22.0 % RT, and 3.3 % RP with adjuvant RT. Among men with low-, intermediate-, and high-risk prostate cancer, 17.2, 7.1, and 15.9 %, respectively, received no definitive therapy. RP was the most common choice of definitive therapy, utilized in 74.6 % of patients. Adjuvant RT after RP was utilized in 16.2 % of cases with positive margin and/or pT3/pT4 disease. African-American race, single marital status, and Medicaid/no insurance were associated with a decreased likelihood of receiving definitive treatment. CONCLUSIONS A significant proportion of younger men diagnosed with localized prostate cancer, particularly with low- or high-risk disease, are not receiving definitive therapy. African-American men, uninsured men, and patients with Medicaid or no medical insurance are less likely to receive definitive treatment.
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Affiliation(s)
- Andrew T Wong
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. .,Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA.
| | - Joseph J Safdieh
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA
| | - Justin Rineer
- UF Health Cancer Center - Orlando Health, Orlando, FL, USA
| | - Joseph Weiner
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA
| | - David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA
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Jespersen CG, Nørgaard M, Jacobsen JB, Borre M. Patient comorbidity is associated with conservative treatment of localized prostate cancer. Scand J Urol 2015; 49:366-70. [DOI: 10.3109/21681805.2015.1026936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christina G Jespersen
- a 1 Departments of Urology and.,c 2 Institute of Clinical Medicine, Aarhus University Hospital , Aarhus N, Denmark
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Camarata AS, Nickleach DC, Jani AB, Rossi PJ. Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive? Health Serv Insights 2015; 8:1-8. [PMID: 25922580 PMCID: PMC4401240 DOI: 10.4137/hsi.s24092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/06/2022] Open
Abstract
Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.
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Affiliation(s)
- Andrew S Camarata
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. ; United States Navy, Medical Corps, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Peter J Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Baade PD, Yu XQ, Smith DP, Dunn J, Chambers SK. Geographic Disparities in Prostate Cancer Outcomes - Review of International Patterns. Asian Pac J Cancer Prev 2015; 16:1259-75. [DOI: 10.7314/apjcp.2015.16.3.1259] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Song L, Rini C, Deal AM, Nielsen ME, Chang H, Kinneer P, Teal R, Johnson DC, Dunn MW, Mark B, Palmer MH. Improving couples' quality of life through a Web-based prostate cancer education intervention. Oncol Nurs Forum 2015; 42:183-92. [PMID: 25806885 PMCID: PMC5123564 DOI: 10.1188/15.onf.183-192] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the feasibility and acceptability of a newly developed web-based, couple-oriented intervention called Prostate Cancer Education and Resources for Couples (PERC). DESIGN Quantitative, qualitative, mixed-methods approach. SETTING Oncology outpatient clinics at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center at UNC–Chapel Hill. SAMPLE 26 patients with localized prostate cancer (PCa) and their partners. METHODS Pre- and postpilot quantitative assessments and a postpilot qualitative interview were conducted. MAIN RESEARCH VARIABLES General and PCa-specific symptoms, quality of life, psychosocial factors, PERC’s ease of use, and web activities. FINDINGS Improvement was shown in some PCa-specific and general symptoms (small effect sizes for patients and small-to-medium effect sizes for partners), overall quality of life, and physical and social domains of quality of life for patients (small effect sizes). Web activity data indicated high PERC use. Qualitative and quantitative analyses indicated that participants found PERC easy to use and understand,as well as engaging, of high quality, and relevant. Overall, participants were satisfied with PERC and reported that PERC improved their knowledge about symptom management and communication as a couple. CONCLUSIONS PERC was a feasible, acceptable method of reducing the side effects of PCa treatment–related symptoms and improving quality of life. IMPLICATIONS FOR NURSING PERC has the potential to reduce the negative impacts of symptoms and enhance quality of life for patients with localized PCa and their partners, particularly for those who live in rural areas and have limited access to post-treatment supportive care.
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Affiliation(s)
- Lixin Song
- the School of Nursing University of North Carolina (UNC)–Chapel Hill and at the UNC Lineberger Comprehensive Cancer Center
| | - Christine Rini
- the Department of Health Behavior in the Gillings School of Global Public Health at the University of North Carolina (UNC)–Chapel Hill and at the UNC Lineberger Comprehensive Cancer Center
| | - Allison M. Deal
- Biostatistician at the UNC Lineberger Comprehensive Cancer Center
| | - Matthew E. Nielsen
- the Division of Urologic Oncology at the UNC Lineberger Comprehensive Cancer Center, as well as an assistant professor in the Department of Urology in the School of Medicine and an adjunct assistant professor in the Departments of Epidemiology and Health Policy and Management at the Gillings School of Global Public Health, all at UNC–Chapel Hill
| | - Hao Chang
- UNC–Chapel Hill and an undergraduate student in the Department of Mathematics at Dartmouth College in Hanover, NH
| | | | - Randall Teal
- Nutrition Communication for Health Applications and Interventions Core at the UNC Lineberger Comprehensive Cancer Center
| | | | - Mary W. Dunn
- both in the Department of Urology, UNC–Chapel Hill
| | - Barbara Mark
- Distinguished Professor in Aging, both in the School of Nursing, all at UNC–Chapel Hill
| | - Mary H. Palmer
- the Helen W. and Thomas L. Umphlet Distinguished Professor in Aging, both in the School of Nursing, all at UNC–Chapel Hill
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African-American Men with Low-Risk Prostate Cancer: Modern Treatment and Outcome Trends. J Racial Ethn Health Disparities 2014; 2:295-302. [PMID: 26863460 DOI: 10.1007/s40615-014-0071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/27/2014] [Accepted: 10/24/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and treatment patterns for African-American (AA) men with low-risk prostate cancer (PCa) using a national, population-based dataset. METHODS We conducted a retrospective review of the Surveillance Epidemiology and End Results database 2004-2008. AA men aged ≥40 years with low-risk PCa were identified. For comparison, white men were selected using the same selection criteria. We reviewed all recorded treatment modalities. Definitive treatment (DT) was defined as undergoing radiotherapy or prostatectomy. RESULTS Overall, 7246 AA men and 47,154 white men met the criteria. Most of the patients had PSA level between 4.1 and 6.9 ng/mL (56.2 %) and received DT (76 %). Black men were younger (mean age: 62(±8) vs. 65(±10) years), less likely to receive DT (adjusted odds ratio (AOR), 0.71 [0.67-0.76]), and of those receiving DT, less likely to undergo prostatectomy (AOR, 0.58 [0.54-0.62]). Patients receiving DT had lower crude cancer-specific and overall mortality (0.17 vs. 0.41 % and 2.9 vs. 7.8 %, p value < 0.001, respectively, among blacks). The difference in overall mortality was largest among ≥ 75 years (5.6 vs. 18.2 %). Across age groups, blacks had higher all-cause mortality (AOR, 1.45 [1.13-1.87] and 1.56[1.31-1.86] for <65 and ≥ 65 years, respectively). CONCLUSION Our study of a large modern cohort of men with low-risk PCa demonstrates significant lower receipt of DT, lower receipt of prostatectomy among those receiving DT, and lower survival for black men compared to their white counterparts. Older men were less likely to receive DT. Patients who received DT had better survival. The survival difference was most striking among the elderly.
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Maurice MJ, Abouassaly R, Zhu H. American trends in expectant management utilization for prostate cancer from 2000 to 2009. Can Urol Assoc J 2014; 8:E775-82. [PMID: 25485003 DOI: 10.5489/cuaj.2073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTON The overtreatment of early prostate cancer has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade. METHODS We examined prostate cancer treatment utilization from 2000 to 2009 using the National Cancer Database. EM use was analyzed in relation to other treatments and by cancer stage, age group, Charlson score, and hospital practice setting. RESULTS Overall, 109 997 (8.2%) men were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for low-stage cancers. Usage was only slightly higher in elderly patients and in patients with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%-29.8% and 15.1%-24.2%, respectively), compared to community hospitals, comprehensive cancer centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for low-stage cancers at Veterans Affairs and low-volume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings. CONCLUSIONS EM utilization remained low and stable last decade, regardless of disease or patient characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in men with low-stage cancers and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.
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Affiliation(s)
- Matthew J Maurice
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Cleveland VA Medical Center; and Cleveland Clinic, Cleveland, OH
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Bell N, Connor Gorber S, Shane A, Joffres M, Singh H, Dickinson J, Shaw E, Dunfield L, Tonelli M. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ 2014; 186:1225-34. [PMID: 25349003 DOI: 10.1503/cmaj.140703] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Neil Bell
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Sarah Connor Gorber
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Amanda Shane
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Michel Joffres
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Harminder Singh
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - James Dickinson
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Elizabeth Shaw
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Lesley Dunfield
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
| | - Marcello Tonelli
- Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Public Health Agency of Canada (Connor Gorber, Shane, Dunfield), Ottawa, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Departments of Family Medicine and Community Health Sciences (Dickinson) and Office of the Associate Dean - Research (Tonelli), University of Calgary, Calgary, Alta.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont
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Hoffman RM, Penson DF, Zietman AL, Barry MJ. Comparative effectiveness research in localized prostate cancer treatment. J Comp Eff Res 2014; 2:583-93. [PMID: 24236797 DOI: 10.2217/cer.13.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prostate-specific antigen testing has dramatically increased the incidence of localized prostate cancer. Most men with localized cancer attempt curative therapy, usually with surgery or radiation. However, there is uncertainty about whether and how to best treat these cancers. No published controlled trials have directly compared surgery against radiation or either treatment against active surveillance. Given the indolent nature of prostate cancer and the substantial risks of treatment-related harms, the effects of cancer and treatment on quality of life are important patient-centered outcomes. Comparative effectiveness research, using observational cohorts, claims data and simulation models, enables comparisons of treatments that have not been studied in controlled trials and captures real-world outcomes data to better support informed decision-making.
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Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
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Survival following primary androgen deprivation therapy for localized intermediate- or high-risk prostate cancer: comparison with the life expectancy of the age-matched normal population. Med Oncol 2014; 31:979. [DOI: 10.1007/s12032-014-0979-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Wang D, Ho A, Hamilton AS, Wu XC, Lo M, Fleming S, Goodman M, Thompson T, Owen J. Type and dose of radiotherapy used for initial treatment of non-metastatic prostate cancer. Radiat Oncol 2014; 9:47. [PMID: 24499610 PMCID: PMC3940027 DOI: 10.1186/1748-717x-9-47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/29/2014] [Indexed: 11/24/2022] Open
Abstract
Background We sought to describe patterns of initial radiotherapy among non-metastatic prostate cancer (PC) patients by recurrence risk groups. Methods Medical records were abstracted for a sample of 9017 PC cases diagnosed in 2004 as a part of the Center for Disease Control and Prevention’s Prostate and Breast Patterns of Care Study in seven states. Non-metastatic PC cases are categorized as low-risk (LR), intermediate-risk (IR) or high-risk (HR) groups based on pretreatment PSA, tumor stage, and Gleason score per 2002 NCCN guidelines. Univariate and multivariate analyses were employed to determine factors associated with the type and dose of radiotherapy by the risk groups. Results Of the 9,017 patients, 3153 who received definitive radiotherapy either alone or in combination with hormone therapy (HT) were selected for in-depth analysis. Multivariate models showed that LR patients were more likely to receive seed implant brachytherapy (BT) than those in higher risk groups. Those in the IR group were most likely to receive external beam radiotherapy (EBRT) combined with BT or high-dose radiotherapy. Use of HT in combination with radiotherapy was more common in the IR and HR groups than for LR patients. Intensity modulated radiation treatment (IMRT) was used to treat 32.6% of PC patients treated with EBRT, with the majority (60.6%) treated with high-dose radiotherapy. Conclusions Radiotherapy types and dosage utilization varied by PC risk groups. Patients in IR were more likely than those in LR or HR to receive high-dose radiotherapy. IMRT was used in about one third of patients to deliver high-dose radiotherapy.
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Affiliation(s)
- Dian Wang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53045, USA.
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Wilson RJ, Ryerson AB, Zhang K, Dong X. Relative survival analysis using the Centers for Disease Control and Prevention's National Program of Cancer Registries Surveillance System Data, 2000-2007. JOURNAL OF REGISTRY MANAGEMENT 2014; 41:72-76. [PMID: 25153012 PMCID: PMC4361070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Cancer survival rates are important in evaluating cancer care, identifying disease patterns, and estimating the probability of death due to cancer. To date, survival rates have been calculated using other data sets with limited population coverage that may not be able to fully identify differences by treatment, geographic region, and racial or ethnic group. Data from the Centers for Disease Control and Prevention's (CDC's) National Program of Cancer Registries (NPCR) have not been used previously to calculate relative survival rates within the United States. METHODS Data from CDC's November 2011 submission for 21 state population-based central cancer registries, representing 50 percent of the US population, were included in this analysis. This paper presents relative survival rates for diagnosis years 2000-2007 with follow-up through 2008. RESULTS The relative survival rate for all cancers and races combined was 65.0 percent (65.3 percent for male and 64.8 percent for female patients). Black patients had a lower relative survival rate than white patients, except for lung and bronchus. For all cancers, the under 45 age groups had the highest relative survival rates, except for black males. DISCUSSION For all cancer primary sites combined for 2000-2007, the CDC NPCR 5-year relative survival rate is comparable to that reported by the National Cancer Institute and the Canadian Cancer Registry. This analysis presents, for the first time, relative survival rates for half of the total US population and demonstrates that reliable survival rates can be calculated using CDC's NPCR data now and in the future.
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Merino T, San Francisco IF, Rojas PA, Bettoli P, Zúñiga A, Besa P. Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up. BMC Cancer 2013; 13:530. [PMID: 24209381 PMCID: PMC3833713 DOI: 10.1186/1471-2407-13-530] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 10/27/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The objective of this work was to assess the overall survival, cause-specific survival and biochemical failure-free survival of a contemporary cohort of patients with localized prostate cancer (PCa) treated with intensity-modulated radiation therapy (IMRT) or radical prostatectomy (RP). METHODS We did a retrospective cohort study of our institution's registry of patients undergoing either IMRT or RP between January 1999 and March 2010, and assessed Prostate Specific Antigen (PSA), age at diagnosis, Gleason score, and digital rectal examination. Two groups were separated according to RP or IMRT treatment and these groups were in turn divided into risk groups according to the D'Amico classification. Overall survival (OS), cause-specific survival (CSS), mortality from other causes (MOC), and biochemical disease-free survival (BDFS) were assessed. RESULTS Twelve-hundred patients were included: 993 in the RP group and 207 in the IMRT group.The IMRT group had older age, PSA at diagnosis and a significantly higher percentage of cancer on the needle biopsy (p <0.001). Of the 207 patients who underwent IMRT, 54% presented comorbidities. Median follow-up was 91.7 months for the RP group and 76 months for the IMRT group. The OS at 5 and 7 was 96.2, and 93.7 for the RP group respectively and 88.4, and 83.1 for the IMRT group respectively (p <0.001). There were no significant differences in the CSS in relation to treatment received among the low- and high-risk groups, while in the intermediate-risk group, patients who underwent to RP had a higher CSS than patients who underwent IMRT (99.6% vs 94.1%, p=0.003). The IMRT group had a significantly better BDFS than the RP group (86.4% vs. 74.3%, respectively, p=0.016). CONCLUSIONS Patients treated with RP were significantly younger and had a better prognosis than patients treated using IMRT, and according to our results, RP had better outcomes in terms of OS while IMRT had greater MOC. Treatment modality did not affect the CSS.
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Affiliation(s)
- Tomás Merino
- Radiotherapy Unit, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile.
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Karlsen RV, Larsen SB, Christensen J, Brasso K, Friis S, Tjønneland A, Dalton SO. PSA testing without clinical indication for prostate cancer in relation to socio-demographic and clinical characteristics in the Danish Diet, Cancer and Health Study. Acta Oncol 2013; 52:1609-14. [PMID: 23978293 DOI: 10.3109/0284186x.2013.831474] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. MATERIAL AND METHODS In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox regression analysis was used to examine associations with mortality. RESULTS PSA testing without clinical indication was less likely among patients > 67 years (OR 0.7; 0.5-1.0). Men who were, PSA tested without clinical indication, were more likely to have vocational training (OR 1.8; 1.1-2.9) or higher education (OR 1.5; 0.9-2.5) and less likely to have advanced disease (OR 0.6; 0.4-0.9). PSA testing without clinical indication more often preceded therapy with curative intent (OR 1.8; 1.1-2.9) and less often palliative treatment (OR 0.6; 0.3-1.0). Men who were PSA tested without clinical indication had non-significantly lower overall and PC-specific mortality [hazard ratios 0.8 (0.5-1.2) and 0.6 (0.3-1.1), respectively]. CONCLUSIONS PSA testing without clinical indication was associated with higher educational level. PC detected by PSA testing with no clinical indication was more often localized and treated with curative intent.
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Affiliation(s)
- Randi V Karlsen
- Danish Cancer Society Research Center , Copenhagen , Denmark
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Nardi AC, Reis RBD, Zequi SDC, Nardozza A. Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology. Int Braz J Urol 2013; 38:155-64; discussion 164-6. [PMID: 22555039 DOI: 10.1590/s1677-55382012000200003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2011] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil. MATERIALS AND METHODS A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice. RESULTS One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA. CONCLUSIONS A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.
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Wenske S, Quarrier S, Katz AE. Salvage Cryosurgery of the Prostate for Failure After Primary Radiotherapy or Cryosurgery: Long-term Clinical, Functional, and Oncologic Outcomes in a Large Cohort at a Tertiary Referral Centre. Eur Urol 2013; 64:1-7. [PMID: 22840351 DOI: 10.1016/j.eururo.2012.07.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
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Master VA, Moses KA. Racial disparities in prostate cancer care: Is adherence to National Comprehensive Cancer Network guidelines good enough for our patients? Cancer 2013; 119:2209-11. [DOI: 10.1002/cncr.28006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/15/2013] [Accepted: 01/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Viraj A. Master
- Department of Urology, Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Kelvin A. Moses
- Division of Urology; Georgia Health Sciences University Cancer Center; Atlanta Georgia
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Loeb S, Berglund A, Stattin P. Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol 2013; 190:1742-9. [PMID: 23727309 DOI: 10.1016/j.juro.2013.05.054] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Prior studies have reported the underuse of deferred treatment (ie active surveillance or watchful waiting) for low risk prostate cancer in the United States. We examined contemporary trends in active surveillance and watchful waiting in the nationwide Swedish prostate cancer registry. We also examined factors associated with selection of deferred management, which might provide insight into the rational diffusion of this important management strategy. MATERIALS AND METHODS We identified 57,713 men with very low risk (T1c, Gleason 6 or less, prostate specific antigen less than 10 ng/ml, prostate specific antigen density less than 0.20 ng/ml/cc, 2 or fewer positive biopsy cores or less than 25% of cores positive), low risk (T1-T2, Gleason 6 or less, and prostate specific antigen less than 10 ng/ml) and intermediate risk prostate cancer (T1-T2, Gleason 7 and/or prostate specific antigen 10 to 20 ng/ml) in the PCBaSe (Prostate Cancer database Sweden) from 1998 to 2011. Subclassification of very low risk disease, and active surveillance vs watchful waiting was possible beginning in 2007. We examined primary treatment selection by risk group and used logistic regression to evaluate factors associated with deferred treatment. RESULTS Overall 13,272 (46%) men with low risk and 8,695 (30%) with intermediate risk prostate cancer chose deferred treatment. Since 2007, 59%, 41% and 16% of very low, low and intermediate risk prostate cancer, respectively, chose active surveillance. Age was by far the strongest determinant of deferred treatment. Education, marital status and comorbidity were significantly but weakly associated with deferring treatment. CONCLUSIONS Deferred treatment for low and intermediate risk prostate cancer was frequently used in Sweden. Dissociating diagnosis from treatment in men with a low risk of progression can decrease the rate of overtreatment.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, New York.
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Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study. Br J Cancer 2013; 109:272-9. [PMID: 23722470 PMCID: PMC3708581 DOI: 10.1038/bjc.2013.268] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/01/2013] [Accepted: 05/10/2013] [Indexed: 11/25/2022] Open
Abstract
Background: Geriatric oncology guidelines state that fit older men with prostate cancer should receive curative treatment. In a population-based study, we investigated associations between age and non-receipt of curative treatment in men with localised prostate cancer, and the effect of clinical variables on this in different age groups. Methods: Clinically localised prostate cancers (T1–T2N0M0) diagnosed from 2002 to 2008 among men aged ⩾40 years, with hospital in-patient episode(s) within 1 year post-diagnosis, were included (n=5456). Clinical and socio-demographic variables were obtained from cancer registrations. Comorbidity was determined from hospital episode data. Logistic regression was used to investigate associations between age and non-receipt of treatment, adjusting for confounders; the outcome was non-receipt of curative treatment (radical prostatectomy or radiotherapy). Results: The percentage who did not receive curative treatment was 9.2%, 14.3%, 48.2% and 91.7% for men aged 40–59, 60–69, 70–79 and 80+ years, respectively. After adjusting for clinical and socio-demographic factors, age remained the main determinant of treatment non-receipt. Men aged 70–79 had a significant five-fold increased risk of not having curative treatment compared with men aged 60–69 (odds ratio (OR)=5.5; 95% confidence interval 4.7, 6.5). In age-stratified analyses, clinical factors had a higher weight for men aged 60–69 than in other age strata. Over time, non-receipt of curative treatment increased among men aged 40–59 and decreased among men aged 70–79. Conclusion: Age remains the dominant factor in determining non-receipt of curative treatment. There have been some changes in clinical practice over time, but whether these will impact on prostate cancer mortality remains to be established.
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Improved survival with surgery in prostate cancer patients without medical comorbidity: a self-fulfilling prophecy? Eur Urol 2013; 64:381-3. [PMID: 23746719 DOI: 10.1016/j.eururo.2013.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/11/2013] [Indexed: 12/22/2022]
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Farioli A, Violante FS, Mattioli S, Curti S, Kriebel D. Risk of mesothelioma following external beam radiotherapy for prostate cancer: a cohort analysis of SEER database. Cancer Causes Control 2013; 24:1535-45. [PMID: 23702885 PMCID: PMC3709083 DOI: 10.1007/s10552-013-0230-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/08/2013] [Indexed: 12/31/2022]
Abstract
Purpose To investigate the association between external beam radiotherapy (EBRT) for prostate cancer and mesothelioma using data from the US Surveillance, Epidemiology, and End Results (SEER) cancer registries. Methods We analyzed data from the SEER database (1973–2009). We compared EBRT versus no radiotherapy. Incidence rate ratios (IRR) and 95 % confidence intervals (95 % CI) of mesothelioma among prostate cancer patients were estimated with multilevel Poisson models adjusted by race, age, and calendar year. Confounding by asbestos was investigated using relative risk of mesothelioma in each case’s county of residence as a proxy for asbestos exposure. Results Four hundred and seventy-one mesothelioma cases (93.6 % pleural) occurred in 3,985,991 person-years. The IRR of mesothelioma was increased for subjects exposed to EBRT (1.28; 95 % CI 1.05, 1.55) compared to non-irradiated patients, and a population attributable fraction of 0.49 % (95 % CI 0.11, 0.81) was estimated. The IRR increased with latency period: 0–4 years, IRR 1.08 (95 % CI 0.81, 1.44); 5–9 years, IRR 1.31 (95 % CI 0.93, 1.85); ≥10 years, IRR 1.59 (95 % CI 1.05, 2.42). Despite the fairly strong evidence of association with EBRT, the population attributable rate of mesothelioma was modest—3.3 cases per 100,000 person-years. The cumulative incidence of mesothelioma attributable to EBRT was 4.0/100,000 over 5 years, 24.5/100,000 over 10 years, and 65.0/100,000 over 15 years. Conclusions Our study provides evidence that EBRT for prostate cancer is a small but detectable risk factor for mesothelioma. Patients should be advised of risk of radiation-induced second malignancies. Electronic supplementary material The online version of this article (doi:10.1007/s10552-013-0230-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Farioli
- Section of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Saverio Violante
- Section of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Section of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefania Curti
- Section of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Kriebel
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA USA
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Ellis SD, Blackard B, Carpenter WR, Mishel M, Chen RC, Godley PA, Mohler JL, Bensen JT. Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina. Cancer 2013; 119:2282-90. [PMID: 23575751 DOI: 10.1002/cncr.28004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/27/2012] [Accepted: 10/08/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared with Caucasian Americans. Racial differences in care are well documented; however, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application. METHODS The medical records of a population-based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors, and National Comprehensive Cancer Network (NCCN) guideline-concordant prostate cancer care. RESULTS African Americans presented with significantly higher Gleason scores (P = .025) and prostate-specific antigen levels (P = .008) than did Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance (P = .055). Across risk categories, African Americans were less likely to have surgery (58.1% versus 68.0%, P = .004) and more likely to have radiation (39.0% versus 27.4%, P = .001) compared with Caucasian Americans. However, 83.5% of men received guideline-concordant care within 1 year of diagnosis, which did not differ by race in multivariable analysis (odds ratio = 0.83; 95% confidence interval = 0.54-1.25). Greater patient-perceived access to care was associated with greater odds of receiving guideline-concordant care (odds ratio = 1.06; 95% confidence interval = 1.01-1.12). CONCLUSIONS After controlling for NCCN risk category, there were no racial differences in receipt of guideline-concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system.
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Affiliation(s)
- Shellie D Ellis
- School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA.
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