Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

DeGroot, Julie; Brundage, Michael; Lam, Miu; Rohland, Susan L.; Heaton, J. W. P.; Mackillop, William J.; Groome, Patti A.

doi:10.5489/cuaj.11294

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…In 2014 the NCCN guidelines were amended, removing the option of AS for those with intermediate risk PC [11]. Up to 12-year survival rates are similar for men with LPC randomized to either observation or RP [12] and RP and radiotherapy survival outcomes are also similar [13]. Despite this, estimated AS uptake rates for men with LPC are 10% [14] and 42% [15] in American and Australian men respectively.…”

Section: Introductionmentioning

confidence: 99%

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

et al. 2014

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Objective: In the past decade localized prostate cancer (LPC) management has been shifting from three radical treatment options (radical prostatectomy, external beam radiotherapy, or brachytherapy) to also include active surveillance (AS). This study examines men with LPC and partners' experiences of choosing between AS and radical treatments, and their experiences of AS when selected.Methods: Qualitative descriptive research design. Interviewed participants were men, and partners of men, who had either chosen radical treatment immediately following diagnosis, or who had been on AS for at least three months. AS was the recommended treatment. Transcribed interviews were thematically analysed and inter-rater reliability integrated.Results: Twenty-one men and 14 partners participated. Treatment decisions reflected varied reactions to prostate cancer information, regularly described as contradictory, confusing, and stressful. Men and partners commonly misunderstood AS but could describe monitoring procedures. Partners often held the perception that they were also on AS. Men and partners usually coped with AS but were sometimes encumbered by treatment decision-making memories, painful biopsies, ongoing conflicting information, and unanswered medical questions. Radical treatment was selected when cancer progression was feared or medically indicated. Some preferred doctors to select treatments.Conclusions: To reduce distress frequently experienced by men diagnosed with LPC and their partners during treatment decision-making and ongoing AS monitoring, the following are needed: improved community and medical awareness of AS; consistent information about when radical treatment is required; and consistent, unbiased information on treatment options, prognostic indicators, and side effects. Regularly up-dated decisional support information/aids incorporating men's values are imperative.

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Section: Introductionmentioning

confidence: 99%

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

et al. 2014

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“…In this context, studies based on several of these data sources have demonstrated that better outcomes might be achieved in high-volume hospitals and/or with more experienced surgeons [21,76]. The evaluation of large cohorts with follow-up data on cancer control has an important role in assessment of the safety and efficacy of PCa treatments [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94]. Data on health-related quality of life after treatment can also be analyzed.…”

Section: 4mentioning

confidence: 99%

Prostate Cancer Registries: Current Status and Future Directions

Gandaglia¹,

Bray

Cooperberg

et al. 2016

European Urology

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Context: Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. Objective: To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. Evidence acquisition: We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate cancer, outcomes, statistical approaches, population-based cohorts, registries of outcomes, and epidemiological studies, alone or in combination. We limited our search to studies published between January 2005 and January 2015. Evidence synthesis: Several population-based and prospective disease-specific registries are currently available for prostate cancer. Studies performed using these data sources provide important information on incidence and mortality, disease characteristics at presentation, risk factors, trends in utilization of health care services, disparities in access to treatment, quality of care, long-term oncologic and health-related quality of life outcomes, and costs associated with management of the disease. Although data from these registries have some limitations, statistical methods are available that can address certain biases and increase the internal and external validity of such analyses. In the future, improvements in data quality, collection of tissue samples, and the availability of data feedback to health care providers will increase the relevance of studies built on population-based and disease-specific registries. Conclusions: The strengths and limitations of PCa registries should be carefully considered when planning studies using these databases. Although randomized controlled trials still provide the highest level of evidence, large registries play an important and growing role in advancing PCa research and care. Patient summary: Several population-based and prospective disease-specific registries for prostate cancer are currently available. Analyses of data from these registries yield information that is clinically relevant for the management of patients with prostate cancer.

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“…This treatment disparity may contribute to poorer survival noted in lung cancer patients with co-morbid HIV infection (7). Though widely used PCa guidelines (23) indicate that RP and radiotherapy are equally appropriate choices for a given risk stratification, emerging data suggest that RP results in improved survival over radiotherapy in men with clinically localized PCa (18–22). In this study, significantly fewer RPs occured in HIV+ men with intermediate risk disease, which is the classification group most likely to benefit from surgery (22, 76).…”

Section: Discussionmentioning

confidence: 99%

“…described PCa treatment in 17 HIV+ patients, however there was no assessment of treatment appropriateness or a seronegative group, limiting the ability to assess for potential disparities (17). Assessing for PCa treatment disparities is important given emerging evidence that curative therapy with radical prostatectomy (RP) may be superior to other modalities like radiotherapy for clinically localized (non-metastatic) disease (18–22). In this study, we compare primary PCa treatments received and appropriateness of PCa treatments between HIV+ and HIV-uninfected (HIV−) men using the widely utilized National Comprehensive Cancer Network (NCCN) PCa treatment guidelines (23)(Supplemental Table 1).…”

Section: Introductionmentioning

confidence: 99%

Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?

Bhatia

Martin

Klein

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background HIV-infected (HIV+) men face cancer treatment disparities which impact outcome. Prostate cancer (PCa) treatment and treatment appropriateness in HIV+ men are unknown. Methods We used electronic chart review to conduct a retrospective cohort study of 43 HIV+ cases with PCa and 86 age- and race-matched HIV-uninfected (HIV−) controls with PCa, aged 40–79, from 2001–2012. We defined treatment appropriateness using National Comprehensive Cancer Network (NCCN) guidelines and the Charlson Co-morbidity Index (CCI) to estimate life expectancy. Results Median age was 59.5 years at PCa diagnosis. Median CD4+ T-cell count was 459.5cells/mm3, 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy (RP) was the primary treatment for 39.5% of HIV+ and 71.0% of HIV− men (p= 0.004). Only 16.3% of HIV+ vs. 57.0% of HIV− men received open RP (p< 0.001). HIV+ men received more radiotherapy (25.6% vs. 16.3%, p= 0.13). HIV was negatively associated with open RP (OR= 0.03, p= 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV+ men received appropriate treatment (89.2% vs. 100%, p= 0.003), due to 4 overtreated HIV+ men. Excluding AIDS from the CCI still resulted in fewer HIV+ men receiving appropriate treatment (94.6% vs. 100%, p = 0.03). Conclusion PCa in HIV+ men is largely appropriately treated. Under-or overtreatment may occur from difficulties in life expectancy estimation. HIV+ men may receive more radiotherapy and fewer RPs, specifically open RPs. Impact Research on HIV/AIDS survival indices and etiologies and outcomes of this PCa treatment disparity in HIV+ men is needed.

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Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

Cited by 6 publications

References 29 publications

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

Prostate Cancer Registries: Current Status and Future Directions

Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?

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