Impact of Asian American race on prostate cancer outcomes

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.

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

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
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.

Strength in Numbers: Perceptions of Political Commonality with African Americans among Asians and Asian Americans in the United States

2018 ◽  
Vol 6 (1) ◽  
pp. 107-122
Author(s):  
Harvey L. Nicholson ◽  
J. Scott Carter ◽  
Arjee Restar
Keyword(s):  
United States ◽  
African Americans ◽  
Asian Americans ◽  
Asian American ◽  
Minority Group ◽  
The United States ◽  
Group Consciousness ◽  
Relational Dynamics ◽  
Linked Fate ◽  
Political Alliances

Asians are now the fastest growing racial minority group in the United States. Nearly 18 million Asians and Asian Americans currently reside in the country. Approximately 44 million African Americans also live in the United States. To improve their limited social, economic, and political clout, Asians and Asian Americans in the United States (AAAUS) could benefit from the formation of mutually beneficial political alliances with African Americans, another historically marginalized racial group. However, complicated relational dynamics between African Americans and AAAUS may drastically reduce the chances of political unity. Using the 2008 National Asian American Survey, the authors examine the effects of three factors—group consciousness, linked fate, and experiences of discrimination—on perceptions of political commonality with African Americans among AAAUS. The findings show that group consciousness and linked fate positively and strongly increase the odds of perceptions of political commonality with African Americans; however, experiences of discrimination do not. The results suggest that the cultivation of mutually beneficial political alliances between African Americans and AAAUS would first require AAAUS to develop a heightened sense of group consciousness and linked fate. The potential impact of these factors on future political alliances between both groups are discussed, as are the limitations of this study.

scholarly journals Does the Presence of a Major Psychiatric Disorder Affect Tolerance and Outcomes in Men With Prostate Cancer Receiving Radiation Therapy?

2016 ◽  
Vol 11 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Joseph J. Safdieh ◽  
David Schwartz ◽  
Justin Rineer ◽  
Joseph P. Weiner ◽  
Andrew Wong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Specific Antigen ◽  
Delayed Diagnosis ◽  
External Beam Radiation ◽  
Definitive Treatment ◽  
Biochemical Control ◽  
Cancer Specific Survival ◽  
Beam Radiation ◽  
Propensity Score Adjustment

Prior studies have suggested that men with prostate cancer and psychiatric disorders (+Psy) have worse outcomes compared with those without (−Psy), particularly due to delayed diagnosis or reduced access to definitive treatment. In the current study, the toxicity and outcomes of men who were primarily diagnosed through prostate-specific antigen screening and who underwent definitive treatment with external beam radiation was investigated. The charts of 469 men diagnosed with prostate cancer from 2003 to 2010 were reviewed. The presence of +Psy was based on a Diagnostic and Statistical Manual of Mental Disorders–Fourth edition diagnosis of posttraumatic stress disorder, depression, schizophrenia, bipolar disorder, and/or generalized anxiety disorder. Kaplan–Meier analysis was used to analyze biochemical control, distant control, prostate cancer–specific survival, and overall survival. One hundred patients (21.3%) were identified as +Psy. At a median follow-up of 73 months, there were no differences regarding 6-year biochemical control (79.8% −Psy vs. 80.4% +Psy, p = .50) or 6-year distant metastatic-free survival (96.4% −Psy vs. 98.0% +Psy, p = .36). There were also no differences regarding the 6-year prostate cancer–specific survival (98.4% −Psy vs. 99.0% +Psy, p = .45) or 6-year overall survival (80.2% −Psy vs. 82.2% +Psy, p = .35). Short- and long-term genitourinary and gastrointestinal toxicities were similar between the groups. On multivariate analyses with propensity score adjustment, +Psy was not a significant predictor for toxicity, biochemical recurrence, or survival. The presence of +Psy was not associated with higher toxicity or worse clinical outcomes, suggesting that effective removal of screening and treatment barriers may reduce the survival disparities of these patients.

Bladder preservation by combined modality therapy for invasive bladder cancer.

1997 ◽  
Vol 15 (3) ◽  
pp. 1022-1029 ◽  
Author(s):  
L A Kachnic ◽  
D S Kaufman ◽  
N M Heney ◽  
A F Althausen ◽  
P P Griffin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Survival Rate ◽  
Combined Modality Therapy ◽  
Clinical Stage ◽  
Survival Rates ◽  
Overall Survival Rate ◽  
Bladder Preservation ◽  
Combined Modality ◽  
Long Term Survivors

PURPOSE To update the efficacy of a selective multimodality bladder-preserving approach by transurethral resection (TURBT), systemic chemotherapy, and radiation therapy. PATIENTS AND METHODS From 1986 through 1993, 106 patients with muscle-invading clinical stage T2 to T4a,Nx,M0 bladder cancer were treated with induction by maximal TURBT and two cycles of chemotherapy (methotrexate, cisplatin, vinblastine [MCV]) followed by 39.6-Gy pelvic irradiation with concomitant cisplatin. Patients with a negative postinduction therapy tumor site biopsy and cytology (a T0 response, 70 patients) plus those with less than a T0 response but medically unfit for cystectomy (six patients), received consolidative chemoradiation to a total of 64.8 Gy. Surgical candidates with less than a T0 response (13 patients) and patients who could not tolerate the chemoradiation (six patients) went to immediate cystectomy. The median follow-up duration is 4.4 years. RESULTS The 5-year actuarial overall survival and disease-specific survival rates of all patients are 52% and 60%, respectively. For clinical stage T2 patients, the actuarial overall survival rate is 63%, and for T3-4, 45%. Thirty-six patients (34%) underwent cystectomy, all with evidence of tumor activity, including 17 with an invasive recurrence. The 5-year overall survival rate with an intact functioning bladder is 43%. Among 76 patients who completed bladder-preserving therapy, the 5-year rate of freedom from an invasive bladder relapse is 79%. No patient required cystectomy for treatment-related bladder morbidity. CONCLUSION Combined modality therapy with TURBT, chemotherapy, radiation, and selection for organ-conservation by response has a 52% overall survival rate. This result is similar to cystectomy-based studies for patients of similar age and clinical stages. The majority of the long-term survivors retain fully functional bladders.

A literature review of the role of brachytherapy in the management of early-stage breast cancer

2019 ◽  
Vol 19 (3) ◽  
pp. 281-290
Author(s):  
Rebecca Thorpe ◽  
Heather Drury-Smith
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Local Recurrence ◽  
Literature Review ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Recurrence Rates ◽  
Overall Survival Rates

AbstractBackground:This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.Methods:The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.Results:Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.Conclusion:In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

Impact of dose-escalated radiation on overall survival in men with nonmetastatic prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 28-28
Author(s):  
Anusha Kalbasi ◽  
Jiaqi Li ◽  
Abigail T. Berman ◽  
Samuel Swisher-McClure ◽  
Marc C. Smaldone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Standard Dose ◽  
Low Risk ◽  
External Beam Radiation ◽  
Risk Category ◽  
Beam Radiation ◽  
Treatment Groups

28 Background: Infive publishedRCTs, dose-escalated external beam radiation therapy (EBRT) for prostate cancer resulted in improved biochemical and local control. However, the question of whether dose escalation improves overall survival (OS) remains unanswered. We examined OS among men with non-metastatic prostate cancer undergoing EBRT in the modern era. Methods: Using the National Cancer Database (NCDB), we conducted non-randomized comparative effectiveness studies of dose-escalated versus standard-dose EBRT in men diagnosed from 2004-2006 in three analytic cohorts defined by NCCN risk category: low- (N=12,848), intermediate- (N=14,966) or high-risk (N=14,587) prostate cancer. We categorized patients in each risk cohort into 2 treatment groups: standard-dose (68.4 Gy to <75.6 Gy) or dose-escalated (≥75.6 Gy to 90 Gy) EBRT. The primary outcome was time to death from any cause, measured from diagnosis to NCDB date of death or end of follow-up (December 31, 2011). We compared OS between treatment groups in the three analytic cohorts using Cox proportional hazard models. Inverse probability weighted propensity score methods were used to balance differences between treatment groups in age, race, year of diagnosis, AJCC T- and N-stage, PSA, Gleason score, androgen deprivation therapy, IMRT use, comorbid disease, income, insurance, urban/rural location, facility type and facility volume. In secondary analyses, we evaluated dose response for survival by categorizing dose in approximately 2 Gy increments. Results: Median follow up for survivors was between 73 and 74 months in all three risk cohorts. Dose-escalated EBRT was associated with improved survival in the intermediate-risk (adjusted HR 0.81, 95% CI 0.77 and 0.85, p<0.0001) and high-risk groups (aHR 0.85, 95% CI 0.81 and 0.89, p<0.0001), but not the low-risk group (aHR 0.99, 95% CI 0.92-1.06, p=0.803). For every incremental ~2Gy increase in dose, there was a 9% (95% CI 6% – 11%, p<0.0001) and 7% (95% CI 3% - 10%, p=0.004) reduction in the hazard of death for intermediate- and high-risk patients, respectively. Conclusions: Dose-escalated EBRT is associated with improved survival in men with intermediate- and high-risk, but not low-risk, prostate cancer.

Survival impact of initial local therapy selection for men under 60 with high risk prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5082-5082
Author(s):  
Adeel Kaiser ◽  
Soren Bentzen ◽  
Minhaj Siddiqui ◽  
Michael J Naslund ◽  
Young Kwok ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Hormonal Therapy ◽  
Local Therapy ◽  
External Beam Radiation ◽  
Comorbidity Score ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
The Impact

5082 Background: The impact of initial local therapy selection on survival for high risk prostate cancer (PCa) patients remains uncertain. We sought to assess this effect, while limiting competing causes of death, through the examination of a younger PCa patient cohort within the National Cancer Database. Methods: We evaluated the overall survival (OS) of men under 60 with high risk PCa receiving either radiation therapy (RT) or radical prostatectomy (RP). All men in this age group were treated between 2004 and 2013, harbored cN0M0 disease, and presented with Gleason Scores (GS) of 8 to 10. The RT group included patients who received external beam radiation (EBRT) alone or EBRT in combination with brachytherapy (BT). Overall survival and covariates were evaluated using multivariable Cox regression analysis. Results: A total of 16,944 patients met inclusion criteria of which 12,155 underwent RP and 4,789 received RT as initial therapy. 82.5% of RT patients received hormonal therapy, and the median dose was 77.4 Gy. In the RP group, 17.2% of patients received postoperative radiation, and 87% of these cases received a dose exceeding 64.80 Gy. The RP group had a higher proportion of cases with Charlson-Deyo comorbidity score > 0 (15.2% v. 11.2%, p < 0.000001). At a median follow-up of 50 months (0 - 131 months), RP was associated with improved OS in comparison to RT (hazard ratio = 0.52; 95% CI (0.47, 0.58); p < 0.000001). The estimated 8-year OS (±1 standard error of the estimate) was 85.1±0.7% and 74.9±0.7%, after RP and RT, respectively. This benefit remained present when adjusting for age, year of treatment, race, comorbidity score, Gleason score, T stage, hormonal therapy, chemotherapy, form of radiation, PSA, or insurance status. Conclusions: Compared to RT, initial treatment of men under 60 with high risk PCa with RP results in a large, statistically significant improvement in overall survival that remains consistent over time and remains significant in a multivariable model adjusting for known prognostic variables. These results are limited by the retrospective nature of the database analysis, and the lack of cancer specific survival information.

Impact of castration resistant status on overall survival for prostate cancer patients treated with radical prostatectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e562-e562
Author(s):  
Naoki Fujita ◽  
Takuya Koie ◽  
Hayato Yamamoto ◽  
Atsushi Imai ◽  
Yuki Tobisawa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Survival Rates ◽  
Specific Antigen ◽  
Pelvic Lymphadenectomy ◽  
Term Survival ◽  
Oncological Outcomes ◽  
Castration Resistant

e562 Background: We estimated the natural history and predictive factors of oncological outcomes in patients with prostate cancer (PCa) after radical prostatectomy (RP). Methods: In this retrospective study, we reviewed the clinical and pathological records of 1083 PCa patients who underwent RP and bilateral pelvic lymphadenectomy with or without neoadjuvant therapy between July 1996 and December 2014 at Hirosaki University. All patients were followed-up by assessing serum prostate-specific antigen (PSA) and testosterone levels every 3 months for 5 years and every 6 months thereafter. The endpoint was the oncological outcomes after surgery. Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model. Results: The 5-year and 10-year overall survival rates were 98.5 % and 92.0 %, respectively. At the end of the study, 226 patients (20.8%) showed biochemical recurrence and 28 patients (2.6%) had developed castration-resistant Pca (CRPC). The patients with CRPC were significantly poor prognosis compared with those without CRPC (P < 0.01). On multivariate analysis, although preoperative variables were no significant differences, only CRPC was significantly associated with OS. Conclusions: RP was shown to provide excellent long-term survival with OS at 10 years. In addition, a small proportion of the patients treated with RP had CRPC and died of Pca within 10 years. Development to castration resistant status may have critical impact on OS.

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