The Changing Face of Low-Risk Prostate Cancer: Trends in Clinical Presentation and Primary Management

Cooperberg, Matthew R.; Lubeck, Deborah P.; Meng, Maxwell V.; Mehta, Seema; Carroll, Peter R.

doi:10.1200/jco.2004.10.062

Cited by 510 publications

(333 citation statements)

References 47 publications

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“…36,37 In addition, age and life expectancy play important roles in treatment choices and subsequent recovery. 38 Still, even when controlling for both age at diagnosis and age at each assessment, ADT demonstrated a strong association with declines in physical function and vitality in our study.…”

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confidence: 64%

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

Sadetsky

Greene

Cooperberg

et al. 2011

Cancer

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BACKGROUND: As androgen deprivation therapy (ADT) becomes a standard of treatment for men with recurrent or metastatic prostate cancer, evaluation of adverse effects associated with this treatment is needed. In this study, the authors evaluated the effect of ADT administered as monotherapy and in combination with local treatment on physical well-being in a longitudinal sample of men with prostate cancer. METHODS: Exposure to ADT was defined by 3 groups: local (local treatment only), combination (local treatment with adjuvant and/or neoadjuvant ADT), and primary ADT. Associations between exposure to ADT and physical well-being measured by self-reported health-related quality of life outcomes over time were evaluated by repeated measures analysis using mixed modeling. Estimates adjusted for various clinical and demographic variables are reported. RESULTS: A total of 2922 men, who completed both pretreatment and follow-up health-related quality of life assessment, were identified from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. During 24 months of follow-up, exposure to ADT was associated with worse physical well-being compared with local treatment at all time points (P < .001). Being exposed to ADT as primary therapy was associated with more severe declines compared with combination therapy. CONCLUSIONS: The potential consequence of decline in physical well-being in patients exposed to ADT has to be included in treatment decision making. Cancer 2011;117:4406-

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confidence: 64%

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

Sadetsky

Greene

Cooperberg

et al. 2011

Cancer

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“…As a result the proportion of patients presenting with hormone naïve, metastatic CaP has decreased substantially in the last 2 decades. 12,16 Here we describe a contemporary cohort of patients in whom metastatic CaP developed after RP, and who were treated with close observation and deferred ADT. We demonstrate that the survival of these hormone naïve patients can be long, and that the presence of pain and a short PSADT during the 24 months preceding metastasis are independent risk factors for PCSM in this cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Practitioners frequently extrapolate the benefits of ADT determined in advanced disease [9][10][11] and apply those same principles to patients with PSA recurrence after RP. 12 However, the efficacy of immediate administration of ADT after PSA recurrence vs deferring ADT until evidence of metastatic disease has not been well established and is a subject of great controversy, 13 while the deleterious effects of long-term ADT are well-known. 14 We demonstrate CaP specific survival and analyze factors influencing it in a contemporary group of hormone naïve men with metastasis (stage D2) after RP, followed closely from the time of PSA increase.…”

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confidence: 99%

The Natural History of Men Treated With Deferred Androgen Deprivation Therapy in Whom Metastatic Prostate Cancer Developed Following Radical Prostatectomy

et al. 2008

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Purpose-We report on the natural history and factors influencing the prognosis of a cohort of hormone naïve, prostate specific antigen era patients in whom metastatic prostate cancer developed after radical prostatectomy who were followed closely and treated with deferred androgen deprivation therapy at the time of metastasis.Materials and Methods-A total of 3,096 men underwent radical prostatectomy performed by a single surgeon at Johns Hopkins Hospital between 1987 and 2005. Of these men 422 had prostate specific antigen failure. Distant metastasis developed in 123 patients, of whom 91 with complete data formed the study cohort initially treated during the prostate specific antigen era (1987 to 2005) and receiving androgen deprivation therapy after documented metastasis. A total of 41 men died of prostate cancer. Median survival times were estimated by Kaplan-Meier analysis. Prognostic impact was estimated as the hazard ratio derived from the Cox proportional hazards model.Results-Median followup from radical prostatectomy was 120 months (range 24 to 216). Kaplan-Meier median (range) times to failure were 24 months (12 to 144) from radical prostatectomy to prostate specific antigen failure, 36 months (0 to 132) from prostate specific antigen failure to metastasis, 84 months (12 to 180) from metastasis to death and 168 months (24 to 216) from radical prostatectomy to death. Statistically significant univariate risk factors for prostate cancer specific mortality at the time of metastasis were pain at diagnosis of metastases (p = 0.002), time from radical prostatectomy to metastasis (p = 0.024) and prostate specific antigen doubling time less than 3 months during the 24 months before metastasis (p = 0.016). Multivariable analysis demonstrated independent predictors of prostate cancer specific mortality at the time of metastasis, namely pain (HR 3.5, p = 0.003) and prostate specific antigen doubling time less than 3 months (HR 3.4, p = 0.017 Radical prostatectomy has been demonstrated to be an effective treatment for prostate cancer, especially when the disease is organ confined. 1-3 As our experience with treating men with RP has increased, we have also learned that many men who are not cured by surgery still may have good outcomes even when evidence of increasing PSA develops. [4][5][6] Androgen signaling events have for many years been known to control CaP cell growth and differentiation, and androgen deprivation therapy has long been a mainstay for the treatment of advanced CaP. 7,8 In the last several years the pattern of practice of ADT for CaP in most of the Western world has been characterized by implementation of treatment before evidence of metastasis. Practitioners frequently extrapolate the benefits of ADT determined in advanced disease [9][10][11] and apply those same principles to patients with PSA recurrence after RP. 12 However, the efficacy of immediate administration of ADT after PSA recurrence vs deferring ADT until evidence of metastatic disease has not been well established and is a s...

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“…6 A growing body of literature supports a role for a trial of active surveillance for carefully selected men with low-risk tumors.7 , 8 We have previously found, however, that on a national level, use of active surveillance (watchful waiting) declined sharply among low-risk patients throughout the 1990s, even as low-risk tumors accounted for a steadily increasing proportion of diagnosed tumors. 9 We conducted the present study with three goals: (1) to update our description of national trends in prostate cancer risk at presentation; (2) to examine whether any new trends in risk are associated with corresponding changes in treatment patterns; and (3) to assess our ability to substratify patients within the low-risk group using the recently validated University of California-San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score.10…”

Section: Introductionmentioning

confidence: 99%

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

et al. 2007

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Purpose-To update national risk trends in prostate cancer with a focus on low-risk tumors, to reexamine trends in primary treatment for low-risk tumors, and to attempt to substratify low-risk patients based on pretreatment clinical data. Materials and Methods-Data were abstracted from the Cancer of the Prostate Strategic UrologicResearch Endeavor (CaPSURE) registry. 10,385 men were diagnosed between 1990 and 2006 with localized disease. Low risk was defined as a prostate-specific antigen (PSA) level ≤10 ng/mL, a Gleason score ≤6, and a clinical T stage ≤2a. Temporal trends were assessed for patient distribution among risk groups and within the low-risk group for individual risk factors, Kattan nomogram prediction, Cancer of the Prostate Risk Assessment (CAPRA) score, and primary treatment. The ability of the CAPRA score to substratify low-risk prostatectomy patients was evaluated with survival analysis.

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The Changing Face of Low-Risk Prostate Cancer: Trends in Clinical Presentation and Primary Management

Cited by 510 publications

References 47 publications

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

The Natural History of Men Treated With Deferred Androgen Deprivation Therapy in Whom Metastatic Prostate Cancer Developed Following Radical Prostatectomy

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

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