Overall Survival in Patients with Localized Prostate Cancer in the US Veterans Health Administration: Is PIVOT Generalizable?

Abstract

A better understanding of overall survival among patients with clinically localized prostate cancer (PCa) in the US Veterans Health Administration (VHA) is critical to inform PCa treatment decisions, especially in light of data from the Prostate Intervention Versus Observation Trial (PIVOT). We sought to describe patterns of survival for all patients with clinically localized PCa treated by the VHA. We created an analytic cohort of 35 954 patients with clinically localized PCa diagnosed from 1995 to 2001, approximating the PIVOT inclusion criteria (age of diagnosis ≤75 yr and clinical stage T2 or lower). Mean patient age was 65.9 yr, and median follow-up was 161 mo. Overall, 22.5% of patients were treated with surgery, 16.6% were treated with radiotherapy, and 23.1% were treated with androgen deprivation. Median survival of the entire cohort was 14.1 yr (25th, 75th percentiles, range: 7.8–18 yr). Among patients who received treatment with curative intent, median survival was 17.9 yr following surgery and 12.9 yr following radiotherapy. One-third of patients died within 10 yr of diagnosis compared with nearly half of the participants in PIVOT. This finding sounds a note of caution when generalizing the mortality data from PIVOT to VHA patients and those in the community. Patient summary More than one-third of patients diagnosed with clinically localized prostate cancer treated through the US Veterans Health Administration from 1995 to 2001 died within 10 yr of their diagnosis. Caution should be used when generalizing the estimates of competing mortality data from PIVOT.

Radical Prostatectomy versus External Beam Radiotherapy - Indication and the Way to the Decision: A Cumulative Non-Interventional Unicentric Retrospective Trial of about 20 Years

“…This clinical trend was also reflected in the reports on primary treatment of clinically localized tumors in a national cohort of the US Veterans Health Administration from 1995 to 2001 [29]. Overall survival in this cohort is also noticeably low in comparison with our findings.…”

“…Barbosa, et al conclude that the better Pivot results cannot be applied generally to the clinical reality in practice [29].…”

PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes

“…In the academic center's database, we identified 18 . Patients in the postpolicy group were slightly older, had more men aged 55 to 74 years, included slightly fewer on Medicare, and had slightly more black and Hispanic patients, but fewer Asian patients compared with the prepolicy group ( Table 1).…”

“…5,15,16 The controversy continued to increase based on criticisms of PLCO citing contamination of the control arm 17 and criticisms of PIVOT for selection of patients with comorbidities and indolent disease. 18 Finally, since 2012, the increased use of active surveillance for management of indolent disease in both the United States and Europe changed the risk/benefit ratio for prostate cancer screening by decoupling screening from treatment-related adverse events. 19 Because of this, in 2018, the USPSTF rolled back the 2012 recommendations and advised men aged 55 to 69 years to discuss the risks and benefits of screening with their healthcare providers (C rating).…”

The Proteome of Prostate Cancer Bone Metastasis Reveals Heterogeneity with Prognostic Implications

“…Despite recent treatment developments for patients with castration-resistant bone metastases (mCRPC), their prognosis remains poor with a median survival below 2 years (4). This is in contrast to patients harboring prostate confined tumors, who have a 10-year cancer-specific survival rate above 90%, even for patients managed by observation protocols (5,6). Why metastatic tumors have a more aggressive behavior than localized tumors is not fully understood.…”