470: Changing Face of Prostate Cancer in the PSA-Era: Results from the CPDR National Database

Abstract Background Intensity-modulated radiation therapy (IMRT) yields better outcomes and fewer toxicities for radiation therapy (RT) of head and neck cancers (HNCs), including nasopharyngeal cancer (NPC). IMRT is the standard RT treatment and has been widely adopted in Western countries to treat HNCs. However, its uptake in clinical practice among NPC patients has never been studied. Methods We investigated the use of IMRT for NPC using data from a nationwide cancer registry to describe the use of IMRT among NPC patients in Japan. We analyzed the data of patients with HNC, including NPC, who underwent IMRT between 2012 and 2014, as recorded in the hospital-based cancer registries linked with insurance claims. We calculated the proportion of patients with NPC who underwent IMRT at each hospital. To evaluate the use of IMRT for NPC, the IMRT use for NPC was compared with the proportion of patients with prostate cancer who underwent IMRT. Results Among 508 patients with NPC who underwent RT at one of 87 hospitals, 348 (69%) underwent IMRT. This proportion gradually increased between 2012 and 2014 (62%, 64% and 77%). Meanwhile, 4790 patients with prostate cancer (90%) underwent IMRT. Although some hospitals where IMRT was performed treated many patients with NPC, the proportion of patients with NPC who were treated with IMRT was low. Conclusions IMRT has not been widely adopted in Japan for treating NPC. Barriers for adopting its use should be identified to close the gap between the standard and actual medical practice in Japan.

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Upgrading on radical prostatectomy specimens of very low- and low-risk prostate cancer patients on active surveillance: A population-level analysis

Canadian Urological Association Journal ◽

10.5489/cuaj.6868 ◽

2020 ◽

Vol 15 (7) ◽

Author(s):

Rashid K. Sayyid ◽

Brandon Wilson ◽

John Z. Benton ◽

Atul Lodh ◽

Eric F. Thomas ◽

...

Keyword(s):

Prostate Cancer ◽

Socioeconomic Status ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Multivariable Analysis ◽

Low Risk ◽

Definitive Treatment ◽

National Database ◽

Lower Odds ◽

Increased Risk

Introduction: A proportion of prostate cancer (PCa) patients initially managed with active surveillance (AS) are upgraded to a higher Gleason score (GS) at the time of radical prostatectomy (RP). Our objective was to determine predictors of upgrading on RP specimens using a national database. Methods: The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database was used to identify AS patients diagnosed with very low- or low-risk PCa who underwent delayed RP between 2010 and 2015. The primary outcome was upgrading to GS 7 disease or worse. Logistic regression analyses were used to evaluate demographic and oncological predictors of upgrading on final specimen. Results: A total of 3775 men underwent RP after a period of AS, 3541 (93.8%) of whom were cT2a; 792 (21.0%) patients were upgraded on RP specimen, with 85.4%, 10.6%, and 3.4% upgraded to GS 7(3+4), 7(4+3), and 8 diseases, respectively. On multivariable analysis, higher prostate-specific antigen (PSA) at diagnosis (5–10 vs. 0–2 ng/ml, odd ratio [OR] 2.59, p<0.001) and percent core involvement (80–100% vs. 0–20%, OR 2.52, p=0.003) were significant predictors of upgrading on final RP specimen, whereas higher socioeconomic status predicted lower odds of upgrading (highest vs. lowest quartile OR 0.75, p=0.013). Conclusions: Higher baseline PSA and percent positive cores involvement are associated with significantly increased risk of upgrading on RP after AS, whereas higher socioeconomic status predicts lower odds of such events. These results may help identify patients at increased risk of adverse pathology on final specimen who may benefit from earlier definitive treatment.

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Racial/Ethnic Patterns in Prostate Cancer Outcomes in an Active Surveillance Cohort

Prostate Cancer ◽

10.1155/2011/234519 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Jennifer Cullen ◽

Stephen A. Brassell ◽

Yongmei Chen ◽

Christopher Porter ◽

James L'Esperance ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Overall Survival ◽

Active Surveillance ◽

Treatment Patterns ◽

External Beam Radiation ◽

National Database ◽

Secondary Treatment ◽

Beam Radiation ◽

Race Ethnicity

Introduction. Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS). This study examined CaP survivors on AS and compared secondary treatment patterns and overall survival by race/ethnicity.Methods. The study population consisted of CaP patients self-classified as black or white followed on AS in the Center for Prostate Disease Research (CPDR) multicenter national database between 1989 and 2008. Secondary treatment included radical prostatectomy (RP), external beam radiation therapy or brachytherapy (EBRT-Br), and hormone therapy (HT). Secondary treatment patterns and overall survival were compared by race/ethnicity.Results. Among 886 eligible patients, 21% were black. Despite racial differences in risk characteristics and secondary treatment patterns, overall survival was comparable across race. RP following AS was associated with the longest overall survival.Conclusion. Racial disparity in overall survival was not observed in this military health care beneficiary cohort with an equal access to health care.

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A retrospective study using the Korea national database for prognosis of prostate cancer in patients with end-stage renal disease (2003-2010)

European Urology Supplements ◽

10.1016/s1569-9056(17)31794-3 ◽

2017 ◽

Vol 16 (10) ◽

pp. e2638

Author(s):

S.H. Kim ◽

J.Y. Joung ◽

Y.A. Kim ◽

J.H. Hong ◽

E.S. Lee ◽

...

Keyword(s):

Prostate Cancer ◽

Retrospective Study ◽

Renal Disease ◽

End Stage Renal Disease ◽

National Database ◽

Stage Renal Disease ◽

End Stage

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Impact of Asian American race on prostate cancer outcomes

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.5165 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 5165-5165

Author(s):

S. A. Brassell ◽

E. Raymundo ◽

Y. Chen ◽

J. Zhao

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

African Americans ◽

Asian Americans ◽

Asian American ◽

Clinical Stage ◽

Survival Rates ◽

External Beam Radiation ◽

National Database ◽

Pathologic Features

5165 Background: The global increased incidence of prostate cancer (CaP) is of growing concern, notably in Asia where a 118% rise has been documented. Recent publications report that Asian Americans are more likely to have advanced clinical stage, higher tumor grades, and worse survival rates compared to other racial groups. It remains unclear if these adverse outcomes are attributable to intrinsic biologic differences of CaP in Asians or socioeconomic and cultural differences. Methods: Men registered into the Center for Prostate Disease Research multi-center military national database from 1989–2007 with biopsy-proven CaP and categorized as Asian American, Caucasian, or African American descent were included. Demographic and clinical characteristics were examined. Frequencies were reported for categorical features. Measures of central tendency and dispersion were reported for continuous features. Chi-square, ANOVA and Kruskal-Wallis test were used to examine association between race and clinico-pathologic features. Differences of PSA recurrence and overall survival rates were analyzed by Kaplan-Meier. The multi-variate Cox proportional hazard model was used to examine predictive value of clinico-pathologic features. Results: Included patients were 10,964: 583 (5.3%) Asian Americans, 2,046 (18.7%) African Americans, and 8,335 (76.0%) Caucasians. At diagnosis, Asian Americans had lower clinical stage (p<0.0001) but worse biopsy grade (p = 0.0006) than other groups. They had a higher percentage of organ confined disease (p < 0.0001) and were more likely to choose radical prostatectomy (RP) (p < 0.0001). Asian Americans had improved biochemical recurrence free (p<0.01) and overall survival (p < 0.001) compared to African Americans or Caucasians treated with RP or external beam radiation. Conclusions: Asian Americans with CaP treated in an equal access military health care system have improved pathologic outcomes and survival characteristics compared with other races. Asian ethnicity's negative impact on survival noted by others appears to be from factors other than the tumor's intrinsic behavior such as language barriers, socioeconomic status, and cultural norms. No significant financial relationships to disclose.

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Longitudinal prostate cancer outcomes in a racially diverse cohort of military heath care beneficiaries: 1990-2017.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16581 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16581-e16581

Author(s):

Jennifer Cullen ◽

Nathan Oehrlein ◽

Samantha Streicher ◽

Huai-Ching Kuo ◽

Yongmei Chen ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Overall Survival ◽

Cancer Progression ◽

Metastatic Cancer ◽

Cox Proportional Hazards ◽

National Database ◽

Racially Diverse ◽

Military Health ◽

Incidence And Mortality

e16581 Background: Prostate cancer (PCa) incidence and mortality disproportionately burden African American (AA) men compared to Caucasian American (CA) men. An interplay of biological, social, and health care factors is blamed for this disparity. However, a recent multi-center study of the Veterans Affairs population found no differences in cancer progression, disease specific survival, or overall survival for AA versus CA men. This study examines a large, racially diverse military health care beneficiary cohort, enrolled over 25+ years, to examine the roles of race and comorbidity on metastasis-free and overall survival. Methods: The Center for Prostate Disease Research (CPDR) multi-center national database was the source of study subjects. Eligible patients included all men who underwent radical prostatectomy (RP) as primary treatment for PCa between January 1, 1990 to December 31, 2017. Comprehensive demographic, clinical, treatment, and outcomes data were collected on all enrollees. Unadjusted Kaplan-Meier estimation curves and multivariable Cox proportional hazards analysis with adjustment for key clinical and pathologic factors were used to examine BCR-free, metastasis-free, and overall survival as a function of patient self-reported race (AA vs. CA). Results: There were 7,135 eligible men, among whom 22% self-reported as AA. Median age at RP and follow-up were 62 and 6.9 years, respectively. A total of 1521 BCR events, 210 metastasis events, and 879 deaths occurred. Compared to CA men, AA men were younger at diagnosis (59.4 vs. 62.7 years, p < 0.05) with higher median PSA (5.8 vs. 5.5 ng/mL, p < 0.05); however, NCCN risk strata, as well as clinical and pathologic stage and grade were distributed comparably across race. Despite slightly poorer BCR-free survival for AA men in both unadjusted and adjusted analysis, there were no statistically significant differences in 5-, 10-, and 15-year probabilities for metastasis-free or overall survival. Conclusions: In this racially diverse equal-access health care setting, this longitudinal cohort study revealed no differences in distant metastasis or overall survival between AA and CA men. Future work will examine molecular signatures of metastatic cancer.

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Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System

Revista de Saúde Pública ◽

10.1590/s1518-8787.2017051006766 ◽

2017 ◽

Vol 51 (0) ◽

Author(s):

Sonia Faria Mendes Braga ◽

Mirian Carvalho de Souza ◽

Raphael Romie de Oliveira ◽

Eli Iola Gurgel Andrade ◽

Francisco de Assis Acurcio ◽

...

Keyword(s):

Prostate Cancer ◽

Health System ◽

Cancer Treatment ◽

Clinical Staging ◽

National Database ◽

Patient Death ◽

Factors Associated ◽

Risk Of Death ◽

Unified Health System ◽

Increased Risk

ABSTRACT OBJECTIVE Analyze the probability of specific survival and factors associated with the risk of death of patients with prostate cancer who received outpatient cancer treatment in the Brazilian Unified Health System, Brazil. METHODS Retrospective cohort study using the National Database of Oncology, developed through the deterministic-probabilistic pairing of health information systems: outpatient (SIA), hospital (SIH) and mortality (SIM). The probability of overall and specific survival was estimated by the time elapsed between the date of the first ambulatory treatment, from 2002 to 2003, until the patient’s death or the end of the study. Fine and Gray’s model of competing-risks regression was adjusted according to the variables: age of diagnostic, region of residence, tumor clinical staging, type of outpatient cancer treatment and hospitalization in the assessment of factors associated with risk of patient death. RESULTS Of 16,280 patients studied, the average age was 70 years, approximately 25% died due to prostate cancer and 20% for other causes. The probability of overall survival was 0.50 (95%CI 0.49–0.52) and the specific was 0.70 (95%CI 0.69–0.71). The factors associated with the risk of patient death were: stage III (HR = 1.66; 95%CI 1.39–1.99) and stage IV (HR = 3.49; 95%CI 2.91–4.18), chemotherapy (HR = 2.34; 95%CI 1.76–3.11) and hospitalization (HR = 1.6; 95%CI 1.55–1.79). CONCLUSIONS The late diagnosis of the tumor, palliative treatments, and worse medical condition were factors related to the worst survival and increased risk of death from prostate cancer patients in Brazil.

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