Association of radical prostate cancer therapy with a survival benefit in the older man.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 66-66
Author(s):  
Paul Cathcart ◽  
Amundeep Johal ◽  
Jan van der Meulen ◽  
Mark Emberton
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Therapy ◽  
Survival Benefit ◽  
Older Men ◽  
Prostate Cancer Therapy ◽  
High Risk Disease ◽  
Specific Mortality ◽  
Radical Therapy ◽  
Cancer Specific Mortality

66 Background: Data from several recent randomised controlled trials have suggested that older men have little to gain from radical prostate cancer therapy. In contrast, observational studies have suggested that older men might be at increased risk of prostate cancer related death than their younger counterparts. Using a national cancer registry, we sought to explore this issue further. Methods: English national mortality records for an 11 year period between 1997 and 2008 were linked to national hospital admission records together with national cancer registration records to generate a working dataset. Complete data were available on 75,735 men. Competing risks regression analysis was employed to identify the effect of age on Prostate Cancer Specific mortality. Results: Older men were more likely to have high-grade prostate cancer (<70 yrs: 20% v’s >79 yrs: 36%) and be staged with locally advanced (<70 yrs: 20% v’s >79 yrs: 35%) or metastatic disease (<70 yrs: 18% v’s >79 yrs: 25%). Older men were less likely to receive radical therapy (<70 yrs: 46% v’s >79 yrs: 4%) although they were more likely to die of their disease. 8-year overall mortality for low, intermediate and high risk disease in men <70 was 8%, 11% and 31% compared to 34%, 36% and 54% for men >79. Comparable figures for 8-year prostate cancer specific mortality were 1%, 5% and 22% for men <70 and 8%, 10% and 32% for men >79.The Number Needed to Treat (NNT) to save one prostate cancer related death for men with low risk disease aged less than 70 was 100 compared to 20 and only 6 for men aged <70 with intermediate and high risk disease respectively. For men aged between 75 and 79, radical prostate cancer therapy was only associated with a survival benefit in men with high risk disease (OR: 0.49, 95% CI 0.36-0.66, p<0.001) for which the NNT was 5. Conclusions: Older men present with more advanced and more aggressive prostate cancer and as such are more likely to die from their disease. Radical therapy was associated with a survival benefit up to the age of 80 providing therapy was targeted to those with higher risk disease.

Brachytherapy boost and cancer-specific mortality in favorable high-risk and other high-risk prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 52-52
Author(s):  
Vinayak Muralidhar ◽  
MIchael H. Xiang ◽  
Peter F. Orio ◽  
Neil E. Martin ◽  
Clair Beard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Survival Benefit ◽  
Intermediate Risk ◽  
High Risk Prostate Cancer ◽  
High Risk Disease ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost ◽  
Cancer Specific Mortality

52 Background: A randomized trial has recently reported improved 5-year biochemical recurrence-free survival with brachytherapy (BT) boost compared with external beam radiation therapy (EBRT) boost in intermediate- to high-risk prostate cancer. Recent retrospective data suggest that BT boost may also confer a cancer-specific survival benefit in the high-risk subgroup. We sought to determine whether this survival benefit would extend to the recently defined favorable high-risk subgroup of prostate cancer patients (T1c, Gleason 4+4 = 8, PSA < 10 ng/mL or T1c, Gleason 6, PSA > 20 ng/mL). Methods: We identified 45,078 patients in the Surveillance, Epidemiology, and End Results database with cT1c-T3aN0M0 intermediate- to high-risk prostate cancer diagnosed 2004-2011 treated with EBRT or EBRT plus BT. We used multivariable competing risks regression to determine differences in the rate of prostate cancer-specific mortality (PCSM) after EBRT+BT or EBRT alone in patients with intermediate-risk, favorable high-risk, or other high-risk disease after adjusting for demographic and clinical factors. Results: BT boost was not associated with an improvement in 5-year PCSM compared with EBRT alone among patients with favorable high-risk disease (1.6% vs 1.9%; adjusted hazard ratio [AHR] 0.56; 95% confidence interval [CI], 0.21 to 1.52, P = 0.258) and intermediate-risk disease (0.7% vs 0.9%; AHR 0.83; 95% CI, 0.59 to 1.16; P = 0.270). Others with high-risk disease had significantly lower 5-year PCSM when treated with BT boost compared with EBRT alone (3.9% vs 5.0%; AHR 0.73; 95% CI, 0.55 to 0.95; P = 0.022). Conclusions: Brachytherapy boost is associated with a decreased rate of PCSM in men with high-risk prostate cancer, but this benefit was not seen among patients with favorable high-risk disease. This suggests that the recently-defined “favorable high-risk” category may be used to personalize therapy for men with high risk disease.

Prostate cancer–specific mortality after definitive radiation therapy: Who dies of disease?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 181-181
Author(s):  
M. M. Kim ◽  
K. E. Hoffman ◽  
L. B. Levy ◽  
S. J. Frank ◽  
S. Choi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
High Risk Disease ◽  
Specific Mortality ◽  
Risk Patients ◽  
Cancer Specific Mortality

181 Background: A competing risks analysis was undertaken to identify patient subgroups at greatest risk of dying from prostate cancer (CAP) after treatment with definitive external beam radiation therapy (RT) +/− androgen deprivation therapy (ADT) in the PSA era, and to determine which factors predict for survival from disease. Methods: A total of 2,675 men with localized CAP treated with RT +/− ADT at M. D. Anderson Cancer Center from 1987-2007 were evaluated. Prostate cancer-specific mortality (PCSM) and other cause mortality rates were calculated after stratifying patients according to NCCN risk group, RT dose, use of ADT, and age at treatment. In total, 21% had low-risk, 40% had intermediate-risk, and 39% had high-risk disease. Multivariate analysis (MVA) was performed using Cox regression modeling. Results: Median age was 68.5 years and median follow-up was 6.4 years. For patients with low-risk disease, only 0.2% died of CAP 10 years after treatment. None of the low-risk patients <70 years old who received ≥72 Gy died of CAP. The majority of deaths in the intermediate-risk group were also due to other causes; men ≥70 years old who received <72 Gy had the highest 10-year PCSM (5%). High-risk patients <70 years old who received <72 Gy without ADT had similar 10-year rates of CAP (15.2%) and non-CAP (18.5%) mortality. Men with high-risk disease <70 years old treated with higher doses >72 Gy were twice as likely to die from non-CAP causes (15.9%) than die from CAP (8.6%). In older men ≥70 years old with high risk disease, dose-escalation with ADT reduced 10-year PCSM from 14% to 4%, and most deaths were due to other causes (41% and 20%). On MVA, dose (p=0.002), ADT (p=0.007), PSA (p<0.0001) and Gleason score (p<0.0001) were predictive of PCSM in the high-risk group. Conclusions: Men with low- and intermediate-risk CAP treated with definitive RT are unlikely to die of disease. PCSM is higher in men with high-risk disease but can be reduced with dose escalation and ADT, although patients are still twice as likely to die of other causes. No significant financial relationships to disclose.

Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 78-78
Author(s):  
David Dewei Yang ◽  
Vinayak Muralidhar ◽  
Brandon Arvin Virgil Mahal ◽  
Marie Vastola ◽  
Ninjiin Boldbaatar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Multivariable Analysis ◽  
High Risk Prostate Cancer ◽  
Positive Biopsy ◽  
Increased Risk ◽  
High Risk Disease ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality

78 Background: A high percent positive biopsy cores (PBC), typically dichotomized at ≥50%, is prognostic of worse cancer-specific outcomes for patients with low- and intermediate-risk prostate cancer. The prognostic value of ≥50% PBC for patients with high-risk disease is poorly understood. We examined the association between ≥50% PBC and prostate cancer-specific mortality (PCSM) for patients with high-risk prostate cancer. Methods: We identified 7,569 men from the Surveillance, Epidemiology, and End Results program who were diagnosed with high-risk prostate cancer (Gleason 8-10, prostate-specific antigen > 20 ng/mL, or cT3-T4 stage without evidence of nodal or metastatic disease) in 2010 or 2011 and had 6-24 cores sampled at biopsy. Multivariable Fine and Gray competing risks regression was utilized to examine the association between ≥50% PBC and PCSM, with adjustments for sociodemographic and clinicopathologic factors. Results: Median follow-up was 3.8 years (interquartile range 3.3-4.3 years). 56.2% of patients (4,253) had ≥50% PBC. The 4-year unadjusted cumulative incidences of PCSM were 2.0% (95% confidence interval [CI] 1.5-2.6%) and 5.6% (95% CI 4.9-6.4%) for patients with < 50% and ≥50% PBC, respectively. On multivariable analysis, the presence of ≥50% PBC was associated with a significantly higher risk of PCSM (adjusted hazard ratio [AHR] 1.95, 95% CI 1.43-2.66, P< 0.001). On subgroup analysis, ≥50% PBC was associated with a significantly higher risk of PCSM only for cT1-T2 disease (AHR 2.21, 95% CI 1.59-3.07, P< 0.001) but not cT3-T4 disease (AHR 0.77, 95% CI 0.33-1.81, P= 0.547), with a significant interaction ( Pinteraction= 0.012). Conclusions: In this large, contemporary cohort of patients with high-risk prostate cancer, ≥50% PBC was independently associated with a two-fold increased risk of PCSM for patients with cT1-T2, but not cT3-T4, tumors. Percent PBC should be used to routinely risk stratify men with high-risk disease and identify patients who may benefit from intensification of therapy, such as adding docetaxel or abiraterone to radiotherapy with androgen deprivation therapy, to optimize cancer-specific outcomes.

Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer

2020 ◽  
Vol 38 (9) ◽  
pp. 735.e9-735.e15
Author(s):  
David D. Yang ◽  
Vinayak Muralidhar ◽  
Brandon A. Mahal ◽  
Marie E. Vastola ◽  
Ninjin Boldbaatar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
High Risk Prostate Cancer ◽  
Positive Biopsy ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality

scholarly journals Subclassification of high-risk clinically organ-confined prostate cancer for early cancer-specific mortality after radical prostatectomy

2016 ◽  
Vol 46 (8) ◽  
pp. 762-767 ◽  
Author(s):  
Takashi Kobayashi ◽  
Takahiro Kimura ◽  
Chunwoo Lee ◽  
Takahiro Inoue ◽  
Naoki Terada ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Early Cancer ◽  
Specific Mortality ◽  
Cancer Specific Mortality

scholarly journals Prostate cancer-specific mortality and the extent of therapy in healthy elderly men with high-risk prostate cancer

Cancer ◽  
2010 ◽  
Vol 116 (11) ◽  
pp. 2590-2595 ◽  
Author(s):  
Karen E. Hoffman ◽  
Ming-Hui Chen ◽  
Brian J. Moran ◽  
Michelle H. Braccioforte ◽  
Daniel Dosoretz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Elderly Men ◽  
High Risk Prostate Cancer ◽  
Healthy Elderly ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality

scholarly journals Validation of a genomic risk classifier to predict metastasis and prostate cancer-specific mortality in men with positive lymph nodes.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 125-125
Author(s):  
Bruce J. Trock ◽  
R. Jeffrey Karnes ◽  
Frank Claessens ◽  
John W. Davis ◽  
Zaid Haddad ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Adjuvant Treatment ◽  
Odds Ratio ◽  
Clinical Model ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Positive Lymph Nodes

125 Background: Men with lymph node involvement (LNI) at prostatectomy (RP) are at high risk of dying from prostate cancer. However, survival following RP is highly variable, with some men apparently cured. Nomograms developed for men with LNI have been based on series where all or the vast majority of men received adjuvant treatment. Because administration of adjuvant treatment is not universal, even for LNI, we evaluated whether the Decipher genomic classifier (GC) can improve upon clinical models to predict metastasis within 5 years (MET5) and prostate cancer specific mortality within 10 years (PCSM10) in a cohort of LNI patients, the majority of whom did not receive adjuvant treatment. Methods: 141 patients from 4 institutions (Johns Hopkins, Mayo Clinic, Leuven, MD Anderson) had LNI at RP, had adequate tissue and clinical data for analysis of MET5, and 86 were analyzed for PCSM10. 43% of men received adjuvant therapy. RP tumor tissue was analyzed by Affymetrix Human Exon 1.0 ST GeneChip; the GC was calculated based on 22 genes in the previously trained and validated algorithm. Logistic regression evaluated whether the GC, dichotomized as high risk (GC score > 0.6) vs low-intermediate risk (≤0.6), improved prediction of MET5 and PCSM10 beyond that achieved with established clinical prognostic factors. Results: 62 men (43%) developed MET5, and 35 (41%) developed PCSM10. For both MET5 and PCSM10 CAPRA-S, number of positive lymph nodes, and age were significant; adjuvant therapy was not significant. GC was a significant independent strong prognostic factor when added to the clinical model for prediction of MET5, odds ratio = 4.04 (95% CI: 1.48, 11.02), p = 0.006, and prediction of PCSM10, odds ratio = 6.71 (95% CI: 2.01, 22.38), p = 0.002. Addition of GC to the clinical model improved the AUC from 0.77 to 0.79 for MET5, and from 0.65 to 0.74 for PCSM10. Conclusions: The Decipher GC significantly improves upon clinical variables to predict metastasis and prostate cancer specific mortality in men at high risk due to LNI. This is the first study to show a genomic classifier predicts outcomes in men with LNI; validation is needed to determine if Decipher can improve treatment decisions in men with LNI.

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