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Braga I, Gonçalves-Monteiro S, Calisto R, Rangel M, Medeiros E, Cunha JL, Rosinha A, Oliveira Â, Fialho AC, Santos S, Redondo P, Bento MJ. Real‑world retrospective study of early‑stage prostate cancer at a Portuguese Comprehensive Cancer Centre: The PEarlC study. Oncol Lett 2024; 28:362. [PMID: 38895053 PMCID: PMC11184360 DOI: 10.3892/ol.2024.14495] [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: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 06/21/2024] Open
Abstract
Despite the high prevalence of localised prostate cancer (LPC) and locally advanced prostate cancer (LAPC), evidence on the characteristics of patients, treatments and clinical outcomes stratified by disease risk is limited. The PEarlC study was conducted to characterise a cohort of patients with early-stage prostate cancer that included real-world clinical outcomes. Retrospective data from a cohort of patients diagnosed with LPC/LAPC between 2015 and 2017 and followed up until December 2020 at a Portuguese comprehensive cancer centre (IPO Porto) was analysed. Patients were classified as LPC (high- or non-high-risk) or LAPC according to European Association of Urology guidelines, were eligible if diagnosed at stage I-III and followed up in Urology, Medical Oncology or Radiation Oncology outpatient clinics of IPO Porto. Data was collected from the medical/administrative records database. Clinical outcomes included prostate-specific antigen (PSA) progression-free survival, metastasis-free survival, disease-free survival, progression-free survival, overall survival (OS), PSA response (palliative) and no evidence of residual tumour (prostatectomy). Time-to-event outcomes were compared between subgroups using the log-rank test. A total of 790 patients were included (54.8% non-high-risk LPC, 30.9% high-risk LPC, 14.3% LAPC) and the median follow-up was 46.7 months. Patients had a median age of 68.0 years. The majority of patients were stage II (52.9%) and Eastern Cooperative Oncology Group 0-1 (99.9%) and received treatment with curative intent (85.4%). The median was only achieved in progression-free survival (29.9 months; 95% CI, 26.5-41.0 months), as evaluated in palliative patients. At year 5, 82.9% were free of PSA progression (curative), 87.5% were metastasis-free, 83.7% were disease-free, all patients in palliative treatment progressed and the 5-year OS rate was 92.9% (CI 95%, 90.2-95.7%). Among patients with LPC, OS was worse in high-risk vs. non-high-risk patients (5-year OS rate, 88.8% vs. 96.8%; hazard ratio=3.34, CI 95%, 1.64-7.05; P=0.001). PSA response rate was 81.4% in the palliative setting. There was no evidence of residual tumour in 61.6% of patients who underwent prostatectomy. Although most patients with early-stage prostate cancer treated at IPO Porto showed positive 5-year real-world outcomes, patients with high-risk LPC showed worse OS compared with patients with non-high-risk LPC and therefore a poorer prognosis. The present large-sample real-world study is an important contribution to reducing the evidence gap on prostate cancer.
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Affiliation(s)
- Isaac Braga
- Department of Urology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Salomé Gonçalves-Monteiro
- Outcomes Research Lab, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Department of Management, Group of Outcomes Research and Economics in Healthcare, Portuguese Oncology Institute of Porto/Porto Research Centre/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Rita Calisto
- Department of Epidemiology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Cancer Epidemiology Group-Research Centre, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Marta Rangel
- Outcomes Research Lab, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Eduardo Medeiros
- Outcomes Research Lab, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - José Luís Cunha
- Outcomes Research Lab, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Department of Management, Group of Outcomes Research and Economics in Healthcare, Portuguese Oncology Institute of Porto/Porto Research Centre/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Alina Rosinha
- Department of Medical Oncology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Ângelo Oliveira
- Department of Radiation Oncology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | | | - Susana Santos
- Johnson & Johnson Innovative Medicine, 2740-262 Porto Salvo, Portugal
| | - Patrícia Redondo
- Outcomes Research Lab, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Department of Management, Group of Outcomes Research and Economics in Healthcare, Portuguese Oncology Institute of Porto/Porto Research Centre/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Maria José Bento
- Department of Epidemiology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Cancer Epidemiology Group-Research Centre, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- Department of Populations Studies, School of Medicine and Biomedical Sciences Abel Salazar of the University of Porto, 4050-456 Porto, Portugal
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Salway SM, Payne N, Rimmer M, Buckner S, Jordan H, Adams J, Walters K, Sowden SL, Forrest L, Sharp L, Hidajat M, White M, Ben-Shlomo Y. Identifying inequitable healthcare in older people: systematic review of current research practice. Int J Equity Health 2017; 16:123. [PMID: 28697768 PMCID: PMC5505033 DOI: 10.1186/s12939-017-0605-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. METHOD A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. RESULTS Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. CONCLUSIONS Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.
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Affiliation(s)
- Sarah M. Salway
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Nick Payne
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Melanie Rimmer
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Stefanie Buckner
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Hannah Jordan
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
| | - Kate Walters
- Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Sarah L. Sowden
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Lynne Forrest
- Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Umbas R, Safriadi F, Mochtar CA, Djatisoesanto W, Hamid ARAH. Urologic cancer in Indonesia. Jpn J Clin Oncol 2015; 45:708-12. [PMID: 26085688 DOI: 10.1093/jjco/hyv066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/22/2015] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases, including cancer, start to become more common in Indonesia. According to the government statement, incidence of malignant diseases increased annually up to 8% in the last decade and these diseases become the seventh leading cause of death in Indonesia. On the basis of the latest Globocan report on cancer incidence in Indonesia, prostate cancer ranks sixth; followed by bladder (12th) and kidney (18th). More than half of patients with kidney cancer are diagnosed in the advanced stage. Besides renal cell carcinoma, there are significant number of people affected with squamous cell and transitional cell carcinoma because of kidney stones. Radical nephrectomy or cytoreductive nephrectomy was the primary treatment, mostly done as an open procedure. Transitional cell carcinoma is the commonest histology type in bladder cancer cases followed by squamous cell carcinoma, which almost always related to bladder stones. Unfortunately, >70% of our cases were diagnosed with muscle invasive bladder cancer, and ∼60% of these patients refused further radical treatment. Incidence of prostate cancer is increasing rapidly and it becomes the third most common cancer in men. However, most of our patients are diagnosed in the advanced stage. Radical prostatectomy or external beam radiotherapy is the treatment of choice in localized disease. Nearly 40% of the elderly patients are treated with primary androgen deprivation therapy. Therefore, it requires more research by the Indonesian urologists and other healthcare providers to diagnose these cancers in earlier stage as well as community education for prevention.
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Affiliation(s)
- Rainy Umbas
- Department of Urology, Faculty of Medicine, University of Indonesia, Jakarta
| | - Ferry Safriadi
- Department of Urology, Faculty of Medicine, Padjadjaran University, Bandung
| | - Chaidir A Mochtar
- Department of Urology, Faculty of Medicine, University of Indonesia, Jakarta
| | - Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Murray NP, Reyes E, Orellana N, Fuentealba C, Jacob O. Prostate cancer screening in the fit Chilean elderly: a head to head comparison of total serum PSA versus age adjusted PSA versus primary circulating prostate cells to detect prostate cancer at initial biopsy. Asian Pac J Cancer Prev 2015; 16:601-6. [PMID: 25684494 DOI: 10.7314/apjcp.2015.16.2.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer is predominately a disease of older men, with a median age of diagnosis of 68 years and 71% of cancer deaths occurring in those over 75 years of age. While prostate cancer screening is not recommended for men>70 years, fit elderly men with controlled comorbidities may have a relatively long life expectancy. We compare the use of age related PSA with the detection of primary malignant circulating prostate cells mCPCs to detect clinically significant PC in this population. MATERIALS AND METHODS All men undergoing PC screening with a PSA>4.0 ng/ml underwent TRUS 12 core prostate biopsy (PB). Age, PSA, PB results defined as cancer/no-cancer, Gleason, number of positive cores and percentage infiltration were registered. Men had an 8 ml blood sample taken for mCPC detection; mononuclear cells were obtained using differential gel centrifugation and mCPCs were identified using immunocytochemistry with anti-PSA and anti-P504S. A mCPC was defined as a cell expressing PSA and P504S; a positive test as at least one mCPC detected/sample. Diagnostic yields for subgroups were calculated and the number of avoided PBs registered. Esptein criteria were used to define small grade tumours. RESULTS A total of 610 men underwent PB, 398 of whom were aged <70 yrs. Men over 70 yrs had: a higher median PSA, 6.24 ng/ml versus 5.59 ng/ml (p=0.04); and a higher frequency of cancer detected 90/212 (43%) versus 134/398 (34%) (p=0.032). Some 34/134 cancers in men<70 yrs versus 22/90 (24%) of men>70 yrs complied with criteria for active surveillance. CPC detection: 154/398 (39%) men<70 yrs were CPC (+), specificity for cancer 86%, sensitivity 88%, 14/16 with a false (-) result had a small low grade PC. In men>70 years, 88/212 (42%) were CPC (+); specificity 92%, sensitivity 87%, 10/12 with a false (-) had small low grade tumours. False (+) results were more common in younger men 36/154 versus 10/88 (p<0.02). With a PSA cutoff of 6.5 ng/ml, in men<70 yrs, 108 PB would be avoided, missing 56 cancers of which 48 were clinically significant. Using CPC detection, 124 biopsies would be avoided, missing only 2 clinically significant cancers. In men>70 yrs using a PSA>6.5 ng/ml would have resulted in 108 PB with 34 PC detected, of which 14(41%) were small low grade tumours. CONCLUSIONS The use of CPC detection in the fit elderly significantly decreases the number of PBs without missing clinically significant cancers, indicating superiority to the use of age-related PSA.
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Affiliation(s)
- Nigel P Murray
- Hematology, Medicine, Hospital de Carabineros de Chile, Santiago, Chile E-mail :
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Taguchi S, Fukuhara H, Kakutani S, Takeshima Y, Miyazaki H, Suzuki M, Fujimura T, Nakagawa T, Igawa Y, Kume H, Homma Y. Risk factors for clinical metastasis in men undergoing radical prostatectomy and immediate adjuvant androgen deprivation therapy. Asian Pac J Cancer Prev 2015; 15:10729-33. [PMID: 25605166 DOI: 10.7314/apjcp.2014.15.24.10729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post- prostatectomy patients who received immediate adjuvant ADT. MATERIALS AND METHODS We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP. RESULTS Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ≥9 and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ≥9 was an independent predictor of cancer-specific death. CONCLUSIONS Pathologic GS ≥9 and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ≥9 was an indispensable condition for bone metastasis, which may imply that patients with GS ≤8 on adjuvant ADT are unlikely to develop bone metastasis.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan E-mail :
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Seo WI, Kang PM, Kim TH, Moon KH, Chung JM, Lee DH, Kim IY, Min K, Chung J, Kim W, Kang DI. Primary androgen deprivation therapy for prostate cancer in koreans: a retrospective multicenter study. World J Mens Health 2014; 32:159-66. [PMID: 25606565 PMCID: PMC4298819 DOI: 10.5534/wjmh.2014.32.3.159] [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: 07/16/2014] [Revised: 09/11/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. MATERIALS AND METHODS Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. RESULTS The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). CONCLUSIONS Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of ≤0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.
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Affiliation(s)
- Won Ik Seo
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Pil Moon Kang
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Kyung Hyun Moon
- Department of Urology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | - Dong Hyun Lee
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Isaac Yi Kim
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Kweonsik Min
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Jaeil Chung
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Wansuk Kim
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Dong Il Kang
- Department of Urology, Inje University College of Medicine, Busan, Korea
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Akman RY, Koseoglu H, Oguzulgen AI, Sen E, Yaycioglu O. Prostate biopsy in the elderly: histologic findings and treatment necessity. Asian Pac J Cancer Prev 2014; 15:8937-9. [PMID: 25374232 DOI: 10.7314/apjcp.2014.15.20.8937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digital rectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to show the characteristics of pathology results. The hospital records of the patients who had high PSA or abnormal digital rectal examination driven prostate biopsy in two common university based research hospitals have been reviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathology results and full medical history were evaluated for the study. A total of 103 patients were evaluated with a mean age of 79.4±3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest were in the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSA levels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal. In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7 or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients had bone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (%79). High percentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perception of prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostate cancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.
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Affiliation(s)
- Ramazan Yavuz Akman
- Department of Urology, School of Medicine, Istanbul Hospital, Bashkent University, Istanbul, Turkey E-mail :
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Verim L, Yildirim A, Basok EK, Peltekoglu E, Pelit ES, Zemheri E, Tokuc R. Impact of PSA and DRE on histologic findings at prostate biopsy in Turkish men over 75 years of age. Asian Pac J Cancer Prev 2014; 14:6085-8. [PMID: 24289630 DOI: 10.7314/apjcp.2013.14.10.6085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.
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Affiliation(s)
- Levent Verim
- Haydarpasa Numune Training and Research Hospital Urology Department, Istanbul, Turkey E-mail :
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Froehner M, Wirth MP. Locally advanced prostate cancer: optimal therapy in older patients. Drugs Aging 2014; 30:959-67. [PMID: 24097331 DOI: 10.1007/s40266-013-0123-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is no standard treatment for locally advanced prostate cancer. Even the definition is still unclear. Locally advanced disease may refer to over-staged well-curable tumors as well as to advanced and probably incurable cancers. Similar uncertainties are present regarding the definition of 'old' in this context. Conservatively treated locally advanced prostate cancer is associated with poor survival outcome. With the increasing life expectancy, in the absence of curative treatment, even patients in their ninth decade of life may later suffer from symptoms of aggressive prostate cancer and are at a high risk of death from prostate cancer that might be prevented at least in part by early intervention. On the other hand, functional results after prostate cancer treatment are worse in elderly patients. In this article we discuss aspects of the management of locally advanced prostate cancer in the elderly with special focus on the recommendation of current clinical guidelines.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Fetscherstrasse 74, 01304, Dresden, Germany,
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Matsumoto K, Hagiwara M, Hayakawa N, Tanaka N, Ito Y, Maeda T, Ninomiya A, Nagata H, Nakamura S. Third-line Hormonal Therapy to Treat Prostate Cancer Relapse after Initial and Second-line Hormonal Therapy: Report of 52 Cases and Literature Review. Asian Pac J Cancer Prev 2014; 15:3645-9. [DOI: 10.7314/apjcp.2014.15.8.3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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