scholarly journals Local variation in primary treatment of localized prostate cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5126-5126
Author(s):  
M. R. Cooperberg ◽  
J. M. Broering ◽  
P. R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Gleason Score ◽  
The United States ◽  
Sociodemographic Factors ◽  
Primary Treatment ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Risk Patients

5126 Background: We aimed to characterize and quantify variation in the primary management of localized prostate cancer at the level of clinical practice sites. Methods: Data were abstracted from patients accrued to the CaPSURE national prostate cancer registry. Patients were accrued from the 36 clinical practice sites which contributed at least 30 patients to the registry, and represented all those diagnosed since 1990 with localized disease who received radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy, active surveillance / watchful waiting (WW), or primary androgen deprivation therapy (PADT) were included. Descriptive analyses were performed, and a random effects logit hierarchical model was constructed, controlling for year of diagnosis, age, comorbidity, PSA, Gleason score, clinical T stage, and percent of biopsy cores positive, to estimate the proportion of variation in primary treatment selection explicable by practice site. Analyses were conducted for all patients and for low-risk patients (Gleason score ≤6, PSA ≤10 ng/ml, clinical stage ≤T2a). Results: 10,080 men were analyzed. The distribution among primary treatments at each clinical practice site varied widely: use of RP, for example, ranged from 12% to 95% of enrolled patients. Patterns of treatment are not reliably explained by patient risk distribution at each site. The proportion of variation attributable to clinical practice sites was 10% for PADT, 19% for WW, 21% for EBRT, 28% for RP, 37% for brachytherapy, and 75% for cryotherapy. For low-risk patients only, this proportion was higher for all treatment types except brachytherapy and cryotherapy. Only a small amount of the variation attributable to practice site can be explained by measured sociodemographic factors such as ethnicity, income, education, and geographic region. There are significant trends in treatments over time, including more use of PADT for intermediate- and high-risk patients, and more use of RP and WW for low-risk patients. Conclusions: These data do not represent a random sampling of the United States population. However, the significant variation in practice patterns across individual clinical sites suggests that factors other than patient clinical and sociodemographic factors may be driving selection of primary treatment. [Table: see text]

scholarly journals Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

2016 ◽  
Vol 34 (18) ◽  
pp. 2182-2190 ◽  
Author(s):  
Ronald C. Chen ◽  
R. Bryan Rumble ◽  
D. Andrew Loblaw ◽  
Antonio Finelli ◽  
Behfar Ehdaie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Clinical Oncology ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cancer Care ◽  
Specific Antigen ◽  
Localized Prostate Cancer ◽  
Risk Category ◽  
American Society

Purpose To endorse Cancer Care Ontario’s guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. Methods The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations. Results The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel. Recommendations For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.

Current clinical presentation and treatment of localized prostate cancer in the United States.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 116-116
Author(s):  
Usama Mahmood ◽  
Lawrence B. Levy ◽  
Paul Linh Nguyen ◽  
Andrew Lee ◽  
Deborah A. Kuban ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Clinical Presentation ◽  
Local Treatment ◽  
Multivariable Analysis ◽  
Sociodemographic Factors ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
High Risk Disease ◽  
The Us

116 Background: This year, the Surveillance, Epidemiology, and End Results (SEER) database released individual patient clinical Gleason score (GS) at the time of biopsy/transurethral resection of the prostate (TURP), which, along with the previously available clinical stage and prostate-specific antigen (PSA), allows a unique opportunity to study the clinical presentation and treatment selection of prostate cancer in the US. Methods: The SEER database was used to identify men diagnosed with localized prostate cancer in 2010 who were then assigned National Comprehensive Cancer Network (NCCN) risk group based on clinical factors at diagnosis. We determined sociodemographic factors associated with having high-risk disease and analyzed the impact of NCCN risk, along with sociodemographic factors, on local treatment selection. Results: A total of 42,403 men were identified of which 16,171 (38%) had low-risk, 16,990 (40%) had intermediate-risk, and 9,242 (22%) had high-risk disease. Older, non-white, and non-married patients living in counties with higher poverty rates, were most likely to be diagnosed with high-risk disease on multivariable analysis. Of the 38,634 men for whom prostate cancer was the first malignancy, 8,832 (23%) had no local treatment, 15,421 (40%) had prostatectomy, 13,855 (36%) had radiation treatment (including external beam radiation and/or brachytherapy), and 526 (1%) had another form of local tumor destruction (predominantly cryotherapy). In total, 29% of low-risk, 16% of intermediate-risk, and 25% of high-risk patients received no local treatment (p < 0.001). On multivariable analysis, older, non-white, and non-married patients living in counties with higher poverty rates who had low-risk disease, were least likely to receive local treatment. Conclusions: Our analysis provides information regarding the current clinical presentation and treatment of localized prostate cancer in the US. We note persistent disparities in the presentation and treatment of prostate cancer according to sociodemographic factors and potential under treatment of high-risk disease.

scholarly journals Economic burden of illness associated with localized prostate cancer in the United States

2020 ◽  
Vol 16 (1) ◽  
pp. 4265-4277 ◽  
Author(s):  
Gary Gustavsen ◽  
Laura Gullet ◽  
Doria Cole ◽  
Nicolas Lewine ◽  
Jay T Bishoff
Keyword(s):  
Prostate Cancer ◽  
Economic Burden ◽  
Burden Of Illness ◽  
The United States ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Decision Analytic Model ◽  
Intermediate Risk ◽  
Novel Therapies ◽  
Risk Patients

Aim: Prior studies have established the economic burden of prostate cancer on society. However, changes to screening, novel therapies and increased use of active surveillance (AS) create a need for an updated analysis. Methods: A deterministic, decision-analytic model was developed to estimate medical costs associated with localized prostate cancer over 10 years. Results: 10-year costs averaged $45,957, $99,445 and $188,928 for low-, intermediate- and high-risk patients, respectively. For low-risk patients, AS 10-year costs averaged $33,912/patient, whereas definitive treatment averaged $49,667/patient. Despite higher failure rates in intermediate-risk patients, AS remained less costly than definitive treatment, with 10-year costs averaging $90,614/patient and $99,394/patient, respectively. Conclusion: Broader incorporation of AS, guided by additional prognostic tools, may mitigate this growing economic burden.

scholarly journals Recommendations by Canadian urologists and radiation oncologists for the treatment of clinically localized prostate cancer

2013 ◽  
Vol 2 (3) ◽  
pp. 197 ◽  
Author(s):  
Andrew Pearce ◽  
Chris Newcomb ◽  
Siraj Husain
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Psa Screening ◽  
Radiation Oncologists ◽  
Risk Prostate Cancer

Objective: Previous work has shown that urologists and radiation oncologists prefer the treatment that they themselves deliver when treating clinically localized prostate cancer. Our objective was to determine whether Canadian radiation oncologists and urologists have similar biases in favour of the treatments that they themselves deliver for localized prostate cancer.Methods: We developed a survey to poll the beliefs that Canadian radiation oncologists and urologists held toward prostate specific antigen (PSA) screening, survival benefits of treatment, recommendations for treatment of prostate cancer and the likelihood of side effects with each therapy.Results: Urologists were more likely to recommend routine PSA screening for men up to age 70 (p < 0.001), while radiation oncologists were more likely to recommend PSA screening for men over age 80 (p < 0.04). More urologists felt that there was “definitely” a survival advantage with radical prostatectomy (RP) (60% v. 21%, p < 0.001). More radiation oncologists recommend external beam radiation therapy (EBRT) (p < 0.01) or brachytherapy (p < 0.03) to treat low-risk prostate cancer. More urologists than radiation oncologists recommend RP for intermediate-risk patients (98% v. 70%, p < 0.001).Conclusion: Most Canadian urologists and radiation oncologists recommend routine PSA screening for men aged 50 to 70. A significant preference was detected among both urologists and radiation oncologists for the treatment that they themselves deliver. While both urologists and radiation oncologists recommend prostatectomy for the treatment of low-risk localized prostate cancer, urologist sare significantly less likely to recommend EBRT. Conversely, when patients present with intermediate-risk prostate cancer, radiation oncologists were significantly less likely than urologists to recommend a prostatectomy.

Role of Radiotherapy in Localized Prostate Cancer

2018 ◽  
Author(s):  
Joelle Helou ◽  
Andrew Loblaw
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Dose Escalation ◽  
Low Risk ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Pathologic Features ◽  
Risk Patients ◽  
Postoperative Setting

Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).   This review contains 2 figures, 5 tables, 1 video and 135 refereces Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy

Role of Radiotherapy in Localized Prostate Cancer

2018 ◽  
Author(s):  
Joelle Helou ◽  
Andrew Loblaw
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Dose Escalation ◽  
Low Risk ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Pathologic Features ◽  
Risk Patients ◽  
Postoperative Setting

Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).   This review contains 2 figures, 5 tables, 1 video and 135 refereces Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy

Determinants of the combined use of external beam radiation therapy and brachytherapy for low-risk localized prostate cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16039-e16039
Author(s):  
Ruben G. W. Quek ◽  
Viraj A. Master ◽  
Kevin C. Ward ◽  
Chun Chieh Lin ◽  
Katherine S. Virgo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Combined Therapy ◽  
Medical Schools ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Radiation Oncologists ◽  
Combined Use ◽  
Region Of Residence

e16039 Background: Prostate cancer treatment patterns have been shown to vary by physician and patient characteristics. For low-risk localized prostate cancer patients, we examined the association between their region of residence and their radiation oncologists’ practice affiliations with medical schools on the likelihood they would receive both external beam radiation therapy (EBRT) and brachytherapy (BT) – a treatment regimen that is at variance with clinical guidelines and has not been shown to improve survival or other patient centered outcomes. Methods: Using the Surveillance, Epidemiology and End Results – Medicare linked database and the American Medical Association Physician Masterfile, we conducted a retrospective cohort study of 4,479 patients aged 66 years or older who were diagnosed between 2004-2007 with low-risk localized prostate cancer, and the 401 radiation oncologists who saw them. Multilevel regression analyses were used to evaluate the influence of patients’ region of residence and radiation oncologists’ practice affiliations with medical schools on the combined use of EBRT and BT on patients within 6 months of diagnosis. Results: Overall, 231 (5.2%) patients received combined EBRT and BT. After adjusting for patient, tumor and radiation oncologist characteristics, patients who saw radiation oncologists with no practice affiliation with medical schools were significantly more likely to receive combined EBRT and BT (odds ratio [OR], 3.14; 95% confidence interval [95% CI], 1.50-6.59, p = 0.003). Regional variations were also observed; the odds of receiving combined therapy for patients residing in California (OR, 0.1; 95% CI, 0.03-0.33, p<0.0001) were significantly less than those in Georgia (OR, 1.0; referent). Conclusions: Low-risk localized prostate cancer patients residing in Georgia were significantly more likely to receive combined EBRT and BT when compared to those in other SEER Regions. Radiation oncologists without practice affiliations with medical schools were significantly more likely to treat patients with combined therapy; such treatment patterns are not consistent with clinical guidelines and unlikely to have significant survival benefit.

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