Survival outcomes of Asian younger men (< 55 years) undergoing radical prostatectomy: a review of prostate cancer database in a tertiary hospital in Singapore

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

Download Full-text

Focal Laser Ablation Versus Radical Prostatectomy for Localized Prostate Cancer: Survival Outcomes From a Matched Cohort

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2019.08.008 ◽

2019 ◽

Vol 17 (6) ◽

pp. 464-469.e3 ◽

Cited By ~ 2

Author(s):

Xiaonan Zheng ◽

Kun Jin ◽

Shi Qiu ◽

Xin Han ◽

Xinyang Liao ◽

...

Keyword(s):

Prostate Cancer ◽

Laser Ablation ◽

Radical Prostatectomy ◽

Cancer Survival ◽

Localized Prostate Cancer ◽

Survival Outcomes ◽

Matched Cohort

Download Full-text

Contemporary Trends and Survival Outcomes After Aborted Radical Prostatectomy in Lymph Node Metastatic Prostate Cancer Patients

European Urology Focus ◽

10.1016/j.euf.2018.01.009 ◽

2019 ◽

Vol 5 (3) ◽

pp. 381-388 ◽

Cited By ~ 7

Author(s):

Marco Bandini ◽

Felix Preisser ◽

Sebastiano Nazzani ◽

Michele Marchioni ◽

Zhe Tian ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Metastatic Prostate Cancer ◽

Survival Outcomes

Download Full-text

Quality of life in young men after radical prostatectomy: Results from the CaPSURE registry

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4576 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4576-4576 ◽

Cited By ~ 1

Author(s):

J. L. Wright ◽

D. W. Lin ◽

J. E. Cowan ◽

J. Duchane ◽

P. R. Carroll ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radical Prostatectomy ◽

Age Groups ◽

Older Men ◽

Multivariate Model ◽

Age Group ◽

Younger Men ◽

One Year

4576 Background: Over the past two decades, the age at diagnosis and treatment of men with prostate cancer (CaP) has steadily declined. Previous work suggests that younger men have similar or improved pathologic and clinical outcomes compared to older men. The literature on quality of life (QOL) following local treatment for CaP has primarily focused on comparing treatment modalities rather than specific age groups. This analysis explored QOL outcomes in younger men following primary curative treatment for localized prostate cancer. Methods: This was a secondary analysis of a prospectively collected cohort from the CaPSURE (Cancer of the Prostate Strategic Urologic Endeavor) registry. Men who underwent radical prostatectomy (RP) for localized disease and completed the UCLA Prostate Cancer Index (PCI) pre- and one-year post-surgery were identified. Men were grouped based on age (< 55, 55–64, ≥ 65 years). A severe decline in PCI domains from pre- to post-RP was defined as a decrease of one standard deviation from the pre-RP score. PCI scores were compared across age groups, and a multivariate model created to analyze the predictors of severe declines in PCI domains. Results: 1,143 men were identified, with 190, 526 and 427 men in the three age groups, respectively. Younger men had significantly higher mean scores one-year after RP in the urinary function (UF), urinary bother (UB) and sexual function (SF) domains of the PCI. The proportion of men with a severe decline in UF, UB and SF was not significantly different in the age groups (range 49–54%, 32–38%, 58–51% respectively). However, a severe decline in SB was more common in the youngest age group than in the oldest (54% vs. 36%, p < 0.01). With the youngest men as the reference group in the multivariate model, the oldest age group was 40% less likely to have a severe decline of SB (OR = 0.60, 95% CI 0.41–0.90, p = 0.04) but trended toward a higher risk of severe decline in UB (OR = 1.27, 95% CI 0.85–1.89, p = 0.08). Conclusions: Age predicts disease-specific QOL changes at one-year following RP. Younger men had significantly better mean UF, UB, and SF domain scores one-year after RP than did their older counterparts. Men < 55 years old are more likely than older men to experience a severe decline of sexual bother but trend toward a lower risk of a severe urinary bother. No significant financial relationships to disclose.

Download Full-text

Advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason score 6 prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.289 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 289-289

Author(s):

Daniel Kim ◽

Ming-Hui Chen ◽

Hartwig Huland ◽

Markus Graefen ◽

Derya Tilki ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Cancer Center ◽

Study Cohort ◽

Pathologic Features ◽

Younger Men ◽

Biopsy Gleason Score ◽

The Impact

289 Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason score 8, 9, 10) at radical prostatectomy (RP) among men with biopsy Gleason score 6 prostate cancer (PC). Methods: The study cohort comprised 3191 men with biopsy Gleason score 6 PC treated with a RP between February 28, 1992 and February 15, 2016 at the Martini-Klinik Prostate Cancer Center. Multivariable logistic regression was used to evaluate the impact of age > 65 years versus younger on the adjusted odds ratio (AOR) of finding adverse pathology at RP adjusting for pre-RP prostate specific antigen (PSA), clinical tumor category, year of diagnosis, percent positive biopsies (PPB), and PSA density (PSAd). Results: Men age > 65 years as compared to younger had significantly lower median PPB (16.67% vs 20.0%; p = 0.01) and PSAd (0.13 ng/mL vs 0.15 ng/mL; p < 0.0001). Yet, while both increasing PPB (AOR 1.018, 95% CI 1.013, 1.023; p- < 0.0001) and PSAd (AOR 4.28, 95% CI 1.66, 11.01; p = 0.003) were significantly associated with an increased odds of finding adverse pathology at RP, men age > 65 years versus younger had a higher odds of adverse pathology at RP (AOR 1.28, 95% CI 1.002, 1.62; p = 0.048). Conclusions: Despite a more favorable median PPB and PSAd, men with biopsy Gleason score 6 PC and who are age > 65 years compared to younger men are at higher risk for having adverse pathology at RP and may benefit from a multiparametric MRI and targeted biopsy before proceeding with active surveillance. If higher grade/stage disease is discovered and treatment indicated then this information could guide both the use and duration of supplemental androgen deprivation therapy in men considering radiation therapy.

Download Full-text