Individual and Population Comparisons of Surgery and Radiotherapy Outcomes in Prostate Cancer Using Bayesian Multistate Models

Beesley, Lauren J.; Morgan, Todd M.; Spratt, Daniel E.; Singhal, Udit; Feng, Felix Y.; Furgal, Allison; Jackson, Will; Daignault, Stephanie; Taylor, Jeremy M. G.

doi:10.1001/jamanetworkopen.2018.7765

Cited by 26 publications

(26 citation statements)

References 54 publications

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“…Patients undergoing radiotherapy are usually older, have more co-morbidities and a more aggressive disease [26]. When developing individualized prediction models for the outcomes (relapse or death), some patient characteristics are associated with different treatment-related outcomes, for example reduced mortality rate in patients with elevated Gleason score choosing EBRT, whereas patients with perineural invasion fared better following surgery [26]. Nevertheless, there is a difference in long-term side-effects between the different treatments.…”

Section: Discussionmentioning

confidence: 99%

Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study

et al. 2020

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Background: Prostate cancer patients are known to suffer from poor sexual and urinary long-term side-effects following treatment, potentially impacting quality of life. The purpose of our study was to compare health-related quality of life at 3 years between prostate cancer patients and healthy controls according to key lifestyle characteristics. Secondary objectives were to compare urological dysfunction, sexual function, anxiety and depression. Methods: Multicentric, case-control, observational prospective, open, follow-up study including 819 prostate cancer patients < 75 years old from the EPICAP cohort, newly diagnosed from 1 December 2011 to 31 March 2014 and 879 healthy controls. Participants were excluded if they experienced a relapse. Controls from the same geographical region were age-matched and were excluded if they were diagnosed with prostate cancer. Patients received one of the following treatments: active surveillance (AS), radical prostatectomy (RP), external beam radiotherapy (EBRT), High-intensity Focused Ultrasound (HIFU), chemotherapy (CT), or androgen deprivation therapy (ADT) as appropriate. The primary outcome was the quality of life as evaluated by the QLQ-C30 questionnaire. Scores were analyzed by multivariate analysis to adjust for predefined socio-demographic confounding effects. Results: In total, 564 participants were included (mean age 67.9 years): 376 patients and 188 controls. Treatment breakdown was: 258 underwent RP, 90 received EBRT, 52 brachytherapy or HIFU, 15 CT, 26 ADT and 61 AS. There was no difference in median global quality of life between patients and controls (94.87 vs 94.15, p = 0.71). Multivariate analysis showed poorer social functioning in patients (24.3% vs. 16.3%, p = 0.0209), more dyspnea (22% vs. 12.4%, p = 0.0078), and yet less current pain (23% vs 33%, p = 0.0151).

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Section: Discussionmentioning

confidence: 99%

Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study

et al. 2020

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“…In this regard, traditional therapeutic approaches have consisted of hormonal therapy, chemotherapy, bisphosphonates, and best supportive care [17][18][19] . The large number of studies accomplished to evaluate the oncological outcomes among PCa patients treated with RP or EBRT have brought conflicting results [20][21][22] . Many evidences obtained from retrospective cohorts have suggested that patients with locally advanced disease could take advantage of active treatment and those subjected to RP should have reduced risk of secondary involvement 23,24 .…”

Section: Management Of Mcrpcmentioning

confidence: 99%

“…Moreover, in the case of localized PCa, the oncologic follow-up is strongly favored by serum PSA dosage, that after RP must be undetectable in the absence of disease relapse 3 . On the other hand, EBRT is a therapeutic option with a radical purpose for localized PCa treatment commonly reserved for older patients, or for patients with comorbidities that contraindicate a major surgical procedure, or in those that prefer to avoid the most frequent side effects caused by surgery, as urinary incontinence and erectile dysfunction 21 . Recent clinical trials 20 Conversely, in advanced stages, EBRT alone appears to be insufficient and therefore patients will need multimodal therapy in a multidisciplinary framework 29 .…”

Section: Rp Vs Ebrt: a Challenging Choicementioning

confidence: 99%

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

Frantellizzi

Costa

Mascia

et al. 2020

Clinical Genitourinary Cancer

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MicroabstractThis study investigates the impact on the overall survival of previous radical primary treatment in mCRPC patients treated with 223-Ra. In this multicenter retrospective study, we enrolled 275 consecutive patients. Results obtained showed a clear advantage for patients subjected to radical primary treatment in respect of those without, with an estimated median survival of 18 months and 11, respectively. AbstractBackground. We provide an analysis aiming to investigate, in a real-life setting, the prognostic relevance of previous primary treatment (radical prostatectomy (RP) or external beam radiotherapy (EBRT)) in terms of overall survival, in mCRPC patients treated with 223-Ra. Materials and methodsIn this multicenter retrospective study we enrolled 275 consecutive patients. Demographics and clinical data, as well as mCRPC characteristics, have been obtained and evaluated at baseline and the end of the treatment or progression. 223-Ra has been administered according to the current label authorization until disease progression or unacceptable toxicity. We divided the whole cohort into 2 groups: men previously treated with primary radical prostatectomy or ablative radiotherapy (RP/EBRT) and patient with no prior primary treatment available (NO). Results128 out of 275 patients (46.5%) are alive and currently on follow-up; 103 patients (37.4%) dropped treatment out for disease progression or onset of comorbidities, and 147 patients died during the follow-up (53.5%). 93 patients underwent RP, 76 patients performed ablative EBRT. 132 patients enrolled in the RP/EBRT group (48%), 143 patients in the NO group (52%).Data showed a clear advantage for patients subjected to RP or EBRT in respect of those without primary treatment performed, with an estimated median survival of 18 months and 11 respectively (p<0.001). The multivariate analysis corroborated this trending results, returning in an HR of 0.7 (p-value= 0.0443), confirming the best outcome of the RP/EBRT group. 3 Conclusions Previous radical treatment plays a protective role in mCRPC patients who underwent 223-Ra treatment.

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“…There was heterogeneity in patients' characteristics as our study was not randomized. Patients undergoing radiotherapy are usually older, have more co-morbidities and a more aggressive disease (26).…”

Section: Discussionmentioning

confidence: 99%

“…When developing individualized prediction models for the outcomes (relapse or death), some patient characteristics are associated with different treatment-related outcomes, for example reduced mortality rate in patients with elevated Gleason score choosing EBRT, whereas patients with perineural invasion fared better following surgery (26). Nevertheless, there is a difference in long-term side-effects between the different treatments.…”

Section: Discussionmentioning

confidence: 99%

Impact on Quality of Life 3 Years After Diagnosis of Prostate Cancer Patients Below 75 At Diagnosis: An Observational Case-Control Study

Houédé

Rébillard²,

Bouvet³

et al. 2020

Preprint

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Background: Prostate cancer patients are known to suffer from poor sexual and urinary long-term side-effects following treatment, potentially impacting quality of life. The purpose of our study was to compare health-related quality of life at 3 years between prostate cancer patients and healthy controls according to key life-style characteristics. Secondary objectives were to compare urological dysfunction, sexual function, anxiety and depression. Methods: Multicentric, case-control, observational prospective, open, follow-up study including 819 prostate cancer patients < 75 years old from the EPICAP cohort, newly diagnosed from 1 December 2011 to 31 March 2014 and 879 healthy controls. Participants were excluded if they experienced a relapse. Controls from the same geographical region were age-matched and were excluded if they were diagnosed with prostate cancer. Patients received one of the following treatments: active surveillance (AS), radical prostatectomy (RP), external beam radiotherapy (EBRT), High-intensity Focused Ultrasound (HIFU), chemotherapy (CT), or androgen deprivation therapy (ADT) as appropriate. The primary outcome was the quality of life as evaluated by the QLQ-C30 questionnaire. Scores were analyzed by multivariate analysis to adjust for predefined socio-demographic confounding effects. Results: In total, 564 participants were included (mean age 67.9 years): 376 patients and 188 controls. Treatment breakdown was: 258 underwent RP, 90 received EBRT, 52 brachytherapy or HIFU, 15 CT, 26 ADT and 61 AS. There was no difference in median global quality of life between patients and controls (94.87 vs 94.15, p=0.71). Multivariate analysis showed poorer social functioning in patients (24.3% vs. 16.3%, p=0.0209), more dyspnea (22% vs. 12.4%, p=0.0078), and yet less current pain (23% vs 33%, p=0.0151). Conclusions: Global health status score at 3 years after diagnosis was similar between patients and controls, though patients showed a significantly worse social functioning. Prostate cancer diagnosis per se does not seem to impact the quality of life of patients <75 years at diagnosis. However, the therapeutic option that will be chosen following diagnosis should be carefully discussed with the medical staff in terms of benefit-risk ratios as it could have a long-term impact on urinary or erectile dysfunction.Trial registration: clinicaltrials.gov, NCT02854982. Registered 4 August 2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02854982

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Individual and Population Comparisons of Surgery and Radiotherapy Outcomes in Prostate Cancer Using Bayesian Multistate Models

Cited by 26 publications

References 54 publications

Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study

Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

Impact on Quality of Life 3 Years After Diagnosis of Prostate Cancer Patients Below 75 At Diagnosis: An Observational Case-Control Study

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