Changes in case mix and treatment patterns in prostate cancer in Saskatchewan during the prostate specific antigen testing era

Tonita, Jon; Skarsgard, David; Muhajarine, Nazeem

doi:10.1007/s10552-008-9234-6

Cited by 2 publications

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References 22 publications

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“…Lower ADT use has been related to fewer cases of late stage PC. With PC screening, migration toward earlier‐stage, lower‐risk cancer has been documented among new patients in the United States [4] and Canada [25]. More effective primary treatments for early disease could mean that fewer patients experience late‐stage cancer.…”

Section: Discussionmentioning

confidence: 99%

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

et al. 2011

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Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Androgen deprivation therapy was originally used for metastatic prostate cancer but is now used to treat all stages of the disease. Once considered to be relatively harmless, androgen deprivation therapy was associated with impaired cognitive function, anemia, loss of muscle strength, osteoporotic fractures, diabetes, and cardiovascular disease by the year 2000. In a large, population‐based sample of prostate cancer patients, the numbers initiating androgen deprivation therapy increased from 1995 to 2001 and then sharply declined to 2005, but the rate of initiation among eligible prevalent cases steadily decreased over that period. Monotherapy with luteinizing hormone‐releasing hormone agonists became the dominant type of androgen deprivation therapy. Changes may be related to fewer cases of late stage disease, potential adverse effects, and new evidence for selected indications and regimens. OBJECTIVE • To describe patterns of initiation of androgen deprivation therapy (ADT) in a population‐based cohort of patients with prostate cancer. PATIENTS AND METHODS • All patients with prostate cancer in Ontario, Canada, who started ≥90 days of ADT at age ≥66 years in 1995–2005 were classified by ADT regimen: medical castration [oestrogen and/or luteinizing hormone‐releasing hormone (LHRH) agonist); orchidectomy; antiandrogen monotherapy; combined androgen blockade (CAB) medical (medical castration plus antiandrogen); CAB surgical (orchidectomy plus antiandrogen). • Indications for ADT were as follows: neoadjuvant (short‐term before prostatectomy or radiation therapy); adjuvant (long‐term with prostatectomy or radiation therapy); metastatic disease; biochemical recurrence; primary (localized disease); other. • We examined trends in ADT regimen and indication over time. RESULTS • The number of patients initiating ADT increased from 1995 to 2001 (2106–2916 per year) and declined thereafter to 2200–2300 annually (total n= 26 809). • However, prostate cancer prevalence doubled over these years, and the rate of ADT initiation decreased from 16 to 7 per 100 person‐years. • Patterns varied by regimen and indication. Medical castration increased from 12% of all ADT in 1995 to 47% in 2005; orchidectomy decreased from 17 to 4%. Use for metastatic disease remained stable, but adjuvant therapy increased from <3% of all ADT in 1995 to 13% in 2005. Primary therapy was the most common indication, but decreased over time. CONCLUSIONS • ADT initiation has fallen and marked changes occurred in treatment patterns for prostate cancer. • Changes might be driven by increasing awareness of potential harms and costs, and by new evidence supporting ADT for specific indications.

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Section: Discussionmentioning

confidence: 99%

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

et al. 2011

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“…For the cases, we also had access to detailed clinical information, including stage, Gleason score and results of PSA testing, which was obtained by abstracting clinical charts of all included prostate cancer cases as part of another research project. The methods of that project are documented in detail elsewhere [23] .…”

Section: Methodsmentioning

confidence: 99%

Use of Non-Steroidal Anti-Inflammatory Drugs and Prostate Cancer Risk: A Population-Based Nested Case-Control Study

et al. 2011

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BackgroundDespite strong laboratory evidence that non-steroidal anti-inflammatory drugs (NSAIDs) could prevent prostate cancer, epidemiological studies have so far reported conflicting results. Most studies were limited by lack of information on dosage and duration of use of the different classes of NSAIDs.MethodsWe conducted a nested case-control study using data from Saskatchewan Prescription Drug Plan (SPDP) and Cancer Registry to examine the effects of dose and duration of use of five classes of NSAIDs on prostate cancer risk. Cases (N = 9,007) were men aged ≥40 years diagnosed with prostatic carcinoma between 1985 and 2000, and were matched to four controls on age and duration of SPDP membership. Detailed histories of exposure to prescription NSAIDs and other drugs were obtained from the SPDP.ResultsAny use of propionates (e.g., ibuprofen, naproxen) was associated with a modest reduction in prostate cancer risk (Odds ratio = 0.90; 95%CI 0.84-0.95), whereas use of other NSAIDs was not. In particular, we did not observe the hypothesized inverse association with aspirin use (1.01; 0.95–1.07). There was no clear evidence of dose-response or duration-response relationships for any of the examined NSAID classes.ConclusionsOur findings suggest modest benefits of at least some NSAIDs in reducing prostate cancer risk.

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Changes in case mix and treatment patterns in prostate cancer in Saskatchewan during the prostate specific antigen testing era

Abstract: There have been dramatic changes in the case mix of prostate cancers diagnosed since the introduction of PSA testing in the population and significant changes in clinical management of this disease. Thus far, no changes have occurred in mortality rates in the population.

Cited by 2 publications

References 22 publications

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

Use of Non-Steroidal Anti-Inflammatory Drugs and Prostate Cancer Risk: A Population-Based Nested Case-Control Study

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