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Delaney RK, Sisco-Taylor BL, Wang X, Scherr K, Ubel PA, Haaland B, Kahn VC, Hamstra D, Wei JT, Madanay F, Davis JK, Greeno TU, Fagerlin A. Two Specialists, Two Recommendations: Discordance Between Urologists' & Radiation Oncologists' Prostate Cancer Treatment Recommendations. Urology 2022; 169:156-161. [PMID: 35768027 PMCID: PMC10049001 DOI: 10.1016/j.urology.2022.06.009] [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: 03/16/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the treatment recommendation patterns among urologists and radiation oncologists, the level of concordance or discordance between physician recommendations, and the association between physician recommendations and the treatment that patients received. METHOD The study was a secondary analysis of data from a randomized clinical trial conducted November 2010 to April 2014 (NCT02053389). Eligible participants were patients from the trial who saw both specialists. The primary outcome was physician recommendations that were scored using an adapted version of the validated PhyReCS coding system. Secondary outcomes included concordance between physician recommendations and the treatment patients received. RESULTS Participants were 108 patients (Mean age 61.9 years; range 43-82; 87% non-Hispanic White). Urologists were more likely to recommend surgery (79% of recommendations) and radiation oncologists were more likely to recommend radiation (68% of recommendations). Recommendations from the urologists and radiation oncologists were concordant for only 33 patients (30.6%). Most patients received a treatment that both physicians recommended (59%); however, 35% received a treatment that only one of their physicians recommended. When discordant, urologists more often recommended surgery and radiation oncologists recommended radiation and surgery as equally appropriate options. CONCLUSION Urologists and radiation oncologists are more likely to differ than agree in their treatment recommendations for the same patients with clinically localized prostate cancer and more likely to favor treatment aligned with their specialty. Additional studies are needed to better understand how patients make decisions after meeting with two different specialists to inform the development of best practices within oncology clinics.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Brittany L Sisco-Taylor
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Xuechen Wang
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Karen Scherr
- Department of Family Medicine and Community Health, Duke University
| | - Peter A Ubel
- Sanford School of Public Policy, Duke University
| | - Benjamin Haaland
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Valerie C Kahn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Daniel Hamstra
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - John T Wei
- Department of Urology, University of Michigan
| | | | | | | | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT; Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance.
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Gomes CM, Favorito LA, Henriques JVT, Canalini AF, Anzolch KMJ, de Carvalho Fernandes R, Bellucci CHS, Silva CS, Wroclawski ML, Pompeo ACL, de Bessa J. Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists. Int Braz J Urol 2020; 46:1042-1071. [PMID: 32539253 PMCID: PMC7527096 DOI: 10.1590/s1677-5538.ibju.2020.99.15] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
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Affiliation(s)
- Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - João Victor T Henriques
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alfredo F Canalini
- Divisão de Urologia, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Karin M J Anzolch
- Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Carlos H S Bellucci
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Caroline S Silva
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | - Marcelo L Wroclawski
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Departamento de Urologia, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | | | - José de Bessa
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
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Shangguan X, Qian H, Jiang Z, Xin Z, Pan J, Dong B, Xue W. Cell cycle progression score improves risk stratification in prostate cancer patients with adverse pathology after radical prostatectomy. J Cancer Res Clin Oncol 2019; 146:687-694. [PMID: 31745702 DOI: 10.1007/s00432-019-03089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the use of the cell cycle progression (CCP) score versus actual risk stratification practice in making treatment decisions for prostate cancer patients with locally adverse pathology after radical prostatectomy (RP). PATIENTS AND METHODS Men with adverse pathologic features, pT3 or positive surgical margins who underwent RP in 2010-2014 at Renji hospital were retrospectively analyzed. The primary outcome was biochemical recurrence (BCR) after RP. RNA was quantified from paraffin-embedded RP specimens. The CCP score was calculated as average expression of 31 CCP genes, normalized to 15 housekeeper genes. The prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards model. RESULTS Among the 100 men identified, 5-year BCR-free survival for the low- (< 0), intermediate- (0-1) and high- (> 1) CCP score groups was 89.3%, 38.8%, and 12.9%, respectively. In multivariable models adjusting for clinical and pathological variables with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score, both continuous CCP score [hazard ratio (HR) 1.373 per unit score, 95% confidence interval (CI) 1.006-1.874; p = 0.046) and the categorized CCP score (p < 0.001)were independent predictors of BCR. CONCLUSIONS The present study provides insights into the role the CCP score plays in risk stratification of this cohort and in determining candidacy for deferred secondary treatment. From our perspective, the CCP score allows better stratification and can help identifying patients at lower risk of disease recurrence who could benefit from a wait-and-see policy.
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Affiliation(s)
- Xun Shangguan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China
| | - Hongyang Qian
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China
| | - Zhou Jiang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China
| | - Zhixiang Xin
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China
| | - Jiahua Pan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China
| | - Baijun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China.
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dong Fang Road, 200127, Shanghai, China.
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Rathbun JT, Schroeder TM, Eberhardt SC. High postprostatectomy prostate-specific antigen level prior to salvage radiation therapy is not always a bad sign. Rev Urol 2018; 19:190-194. [PMID: 29302244 DOI: 10.3909/riu0754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although radical prostatectomy is a popular treatment modality for clinically localized prostate cancer, 10-year biochemical recurrence can reach 28%. Before salvage radiation therapy (SRT), prostate-specific antigen (PSA) values alone should be used cautiously in predicting SRT eligibility. A long, slow PSA rise may suggest locally confined disease still amenable to SRT; corresponding imaging to identify potential gross recurrence is useful. Patients with local disease may safely benefit from higher doses of radiation.
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Affiliation(s)
- John T Rathbun
- Department of Radiation Oncology, University of New MexicoAlbuquerque, NM
| | - Thomas M Schroeder
- Department of Radiation Oncology, University of New MexicoAlbuquerque, NM
| | - Steven C Eberhardt
- Departmant of Diagnostic Radiology, University of New MexicoAlbuquerque, NM
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5
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Abuodeh YA, Naghavi AO, Juan TH, Ma Z, Wilder RB. Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses. Int Braz J Urol 2017; 43:628-637. [PMID: 28379660 PMCID: PMC5557437 DOI: 10.1590/s1677-5538.ibju.2016.0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant” setting starting within 4 months of radical prostatectomy for adverse features; and “salvage” setting for a PSA≥0.2ng/mL. Materials and Methods Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively. Results Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively). Conclusions There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.
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Affiliation(s)
- Yazan A Abuodeh
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Tzu-Hua Juan
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Zhenjun Ma
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Wong AT, Schwartz D, Lee A, Safdieh J, Osborn V, Schreiber D. Patterns of Postprostatectomy Adjuvant Radiotherapy Techniques for Nonmetastatic Prostate Cancer in a Large National Cohort. Clin Genitourin Cancer 2016; 15:168-175. [PMID: 27542509 DOI: 10.1016/j.clgc.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/24/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the contemporary patterns of care regarding adjuvant radiotherapy (RT) techniques for patients with pT3/4 disease or positive margins after prostatectomy. PATIENTS AND METHODS Men who were diagnosed with nonmetastatic prostate cancer and underwent prostatectomy between 2004 and 2012 were abstracted from the National Cancer Data Base. Only those with pT3-4Nx-0M0 or pT2cNx-0M0 with positive margins were included. We identified patients receiving RT to the pelvis to a dose between 5940 and 7560 cGy. Delivery of hormone therapy was also identified. Descriptive statistics were used to determine adjuvant RT use as well as patterns of care regarding RT dose and hormone use; data were compared by Pearson's chi-square test. RESULTS A total of 133,874 men were included in this study, of whom 12,073 (9.0%) received adjuvant RT. Of those receiving adjuvant RT, 4011 (33.2%) also received hormone therapy. There was a trend toward more frequent use of higher RT doses over time. RT doses of ≥ 7000 cGy were provided 21.4% of the time in 2004-2006 and increased over time to 38.9% by 2010-2012 (P < .001). There was also a rapid increase in the use of intensity-modulated radiotherapy from 20.7% of patients in 2004 to 69.2% in 2012. CONCLUSION Most men (91.0%) with pT3/T4 or pT2 disease with positive margins do not receive adjuvant RT. Use of intensity-modulated radiotherapy and RT dose escalation increased over time and are now used routinely. Hormone therapy is used in about one third of patients who are receiving RT, and its use has remained relatively stable over time.
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Affiliation(s)
- Andrew T Wong
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY.
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Anna Lee
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Joseph Safdieh
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Virginia Osborn
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY
| | - David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY
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7
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Grob BM, Torre TG, Petrossian A. Radiotherapy After Radical Prostatectomy: Adjuvant Versus Salvage Approach. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00047-5] [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] Open
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8
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Gómez Caamaño A, Zapatero A, López Torrecilla J, Maldonado X. Management of prostate cancer patients following radiation therapy after radical surgery referred from urology to radiation oncology departments in Spain. Clin Transl Oncol 2015; 18:884-92. [PMID: 26621508 DOI: 10.1007/s12094-015-1454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To define usual clinical management of prostate cancer (PCa) patients following postoperative radiation therapy (RT) (adjuvant or salvage) and its evolution over time in radiation oncology (RO) departments in Spain. METHODS An epidemiological, cross-sectional, multicentre study was conducted. 567 PCa patients that had undergone radical prostatectomy (RP) and received postoperative RT between February and December of both 2006 and 2011 participated in the study. In patients from 2006, health-related quality of life (HRQoL) was assessed using the EPIC questionnaire. Investigators completed a specific survey on two clinical cases of adjuvant and salvage RT. RESULTS 70.6 % of patients received salvage RT versus 29.4 % who received adjuvant RT; no significant differences were found in terms of frequency for each procedure between both the years. Regarding the survey, a positive surgical margin was the main criteria used in adjuvant RT decision making. In terms of salvage RT scenario, 85.7 % of the investigators stated that adjuvant RT should have been offered instead, 81.4 % of the investigators agreed on a PSA score >0.2 ng/mL as the main criteria for identifying biochemical recurrence after RP, and 67.4 % of investigators did not consider any PSA score for ruling out salvage RT treatment. CONCLUSIONS Most patients are referred to RO departments to receive salvage RT. Despite the publication of three IA evidence level randomized clinical trials, the patterns for using adjuvant and salvage RT did not change from 2006 to 2011, although patients' profile did. A consensus regarding postoperative RT indications should be reached in order to correct this controversial situation.
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Affiliation(s)
- A Gómez Caamaño
- Servicio de Oncología Radioterápica Hospital Universitario de Santiago de Compostela, Tr. Choupana s/n, Compostela, Spain.
| | - A Zapatero
- H. Universitario de La Princesa de Madrid, Madrid, Spain
| | | | - X Maldonado
- H. Universitari Vall d'Hebron de Barcelona, Barcelona, Spain
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9
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Lupattelli M, Alcusky M, Aristei C, Bellavita R, Jereczek-Fossa BA, McAna J, Showalter TN, Maio V. Adjuvant and salvage radiation therapy after prostatectomy: investigating beliefs and practices of radiation oncologists. Br J Radiol 2015; 88:20150587. [PMID: 26393481 DOI: 10.1259/bjr.20150587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Evidence regarding adjuvant radiation therapy (ART) and salvage radiation therapy (SRT) following radical prostatectomy (RP) for prostate cancer is inconsistent. The study objectives were to collect survey information on Italian radiation oncologists' (RO) beliefs regarding the use of ART and SRT following RP and to compare the results of Italian RO with those of American RO available from an analogous survey. METHODS A modified version of a US-based questionnaire captured attitudes and clinical approaches regarding post-RP RT of all 716 RO practicing in 147 radiation oncology centres in Italy. Bivariate analyses compared the responses of Italian RO with those of American RO retrieved from a previously published study. RESULTS Analysable questionnaires were completed by 153 Italian RO (response rate, 21%). Variations in practice were found for RT use, timing, dosage and technique. All Italian RO supported ART use, although factors influencing the decision to initiate ART varied. Most RO (81%) would wait 3-6 months after surgery before beginning RT. Compared with Italian RO, more American RO believed ART improves survival outcomes (70% vs 35%, p < 0.001), would initiate ART based solely on adverse pathological features (79% vs 69%, p < 0.001) and would initiate SRT based on any detectable prostate-specific antigen (37% vs 11%, p < 0.001). CONCLUSION Italian RO strongly supported ART, but their approach to patient selection for ART and SRT varied. Striking differences between Italian RO and American RO regarding ART and SRT practices were found. ADVANCE IN KNOWLEDGE Differential RT practices and perceptions exist among RO internationally. Clinical studies must inform evidence-based guidelines to harmonize the use of post-RP RT.
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Affiliation(s)
- Marco Lupattelli
- 1 Radiation Oncology Center, Perugia General Hospital, Perugia, Italy
| | - Matthew Alcusky
- 2 College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cynthia Aristei
- 3 Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Rita Bellavita
- 1 Radiation Oncology Center, Perugia General Hospital, Perugia, Italy
| | - Barbara A Jereczek-Fossa
- 4 Department of Radiotherapy, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy
| | - John McAna
- 2 College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Timothy N Showalter
- 5 Radiation Oncology, University of Virginia Health System, Charlottesville, VA, USA
| | - Vittorio Maio
- 2 College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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10
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Simon RM, Howard LE, Freedland SJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Vidal AC. Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: is adjuvant radiation warranted? BJU Int 2015; 117:897-903. [PMID: 26010251 DOI: 10.1111/bju.13182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. PATIENTS AND METHODS We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. RESULTS On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001). CONCLUSIONS Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.
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Affiliation(s)
- Ross M Simon
- Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA
| | - Martha K Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.,Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Christopher J Kane
- Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA
| | | | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.,Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Adriana C Vidal
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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11
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Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: What should we care about? World J Urol 2015; 33:1973-8. [PMID: 25939539 DOI: 10.1007/s00345-015-1580-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). METHODS Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). RESULTS The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038]. CONCLUSION Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.
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Affiliation(s)
- Caroline Pettenati
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
| | - Yann Neuzillet
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Camelia Radulescu
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Jean-Marie Hervé
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Vincent Molinié
- Department of Pathology, Fort de France University Hospital, Fort de France, France
| | - Thierry Lebret
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
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Türkeri LN. Words of wisdom: Re: Risk stratification of patients with extraprostatic extension and negative lymph nodes at radical prostatectomy: identifying optimal candidates for adjuvant therapy. Eur Urol 2014; 65:1010-1. [PMID: 24646495 DOI: 10.1016/j.eururo.2013.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Levent N Türkeri
- Department of Urology, Marmara University Hospital, Istanbul, Turkey.
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