Incidence and severity of prostate cancer (PCa) in 792 hypogonadal men with and without long-term testosterone therapy (TTh): Results from a controlled registry study.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 167-167
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Observation Time ◽  
Testosterone Undecanoate ◽  
Total Observation Time ◽  
Total Observation

167 Background: There is no evidence that TTh in hypogonadal men increases PCa incidence or severity. A US-Scandinavian group recently found that men receiving TTh had lower risk of aggressive PCa (Loeb S et al., J Clin Oncol 2017; 35:1430-6). Methods: 412 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 12 years. 380 hypogonadal men (57-74) opted against TTh. Median follow-up: 9 years. Total observation time covered approximately 6,400 patient-years. Prostate volume (PV) and PSA were measured and digital rectal examination/transrectal ultrasound performed before treatment/observation initiation and then every 3-6 months (T-group) or once or twice per year (CTRL). Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, 11 men (2.7%) were diagnosed with PCa. In CTRL, 34 (8.9%) were diagnosed with PCa. The incidence per 10,000 years was 33 in the T-group and 108 in CTRL. The mean baseline age of PCa patients was 65.2 years in the T-group and 64.3 in CTRL. All PCa diagnoses in the T-group were made within the first 18 months of treatment initiation. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy was performed in all men. All but 1 patient had a Gleason score (GS) ≤6, and all but 1 a predominant GS of 3. Tumor grade was G2 in all 11 (100%), tumor stage T2a in 7 (64%), T2b in 3 (27%), and T2c in 1 (9%) patient(s). In CTRL, radical prostatectomy was performed in all but 6 patients. GS was > 6 in all 34 patients. 7 men had a GS of 7, 17 a GS of 8, and 10 a GS of 9. 2 men had a predominant Gleason score of 3, 22 had 4, and 10 had 5. Tumor grade was G2 in 6 (17.6%) and G3 in 28 (82.4%) patients, tumor stage T2c in 1 (0.3%), T3a in 3 (8.8%), T3b in 13 (38.2%) and T3c in 17 (50%) patients. In CTRL, biochemical recurrence occurred in 8 (23.5%) patients. These patients received androgen deprivation therapy (ADT). 10 (29.4%) patients died of whom 5 were on ADT. In the T-group, there were no biochemical recurrences or deaths during the observation time. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group.

Prostate cancer (PCa) in 696 hypogonadal men with and without long-term testosterone therapy (TTh): Results from a controlled registry study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5085-5085
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider
Keyword(s):  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Observation Time ◽  
Control Group ◽  
Testosterone Undecanoate ◽  
Total Observation

5085 Background: There is no evidence that TTh in men with hypogonadism increases PCa incidence or severity. A Canadian group recently found that long-term TTh decreased the risk of PCa diagnosis (Wallis et al., Lancet Diab Endocrinol 2016; 4:498). We assessed incidence and severity of PCa in hypogonadal men on long-term TTh (T-group) in comparison to an untreated hypogonadal control group (CTRL). Methods: 400 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 10 years. 296 hypogonadal men (57-74) opted against TTh. Median follow-up: 8 years. Total observation time covered more than 5,000 patient-years. Prostate volume (PV), PSA, weight and C-reactive protein (CRP) were measured and digital rectal examination/transrectal ultrasound performed before treatment initiation and then every 6-12 months. Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, PV increased slightly but significantly by 2.41 mL (p < 0.0001), PSA by 0.22 (NS). In CTRL, PV decreased slightly but significantly by -1.20 mL (p < 0.005), PSA by -0.38 (p < 0.0001). Weight dropped by 18.23% in the T-group and increased by 1.78% in CTRL, CRP decreased significantly in the T-group and remained unchanged in CTRL. In the T-group, 9 men (2.3%) were diagnosed with PCa. In CTRL, 15 (5.1%) were diagnosed with PCa. The incidence per 10,000 years was 29 in the T-group and 102 in CTRL. The mean baseline age of PCa patients was 65 years in the T-group and 65.5 in CTRL. Prostatectomy was performed in all men. In the T-group, all but 1 patient had a Gleason score ≤6, and all a predominant Gleason score of 3. Tumor grade was G2 in all 9 (100%), tumor stage T2a in 7 (78%) and T2b in 2 (22%) patients. In CTRL, Gleason score was > 6 in all 15 patients. 4 men had a predominant Gleason score of 3, 10 had 4, and 1 had 5. Tumor grade was G2 in 7 (46.7%) and G3 in 8 (53.3%) patients, tumor stage T2b in 1 (6.7%), T2c in 1 (6.7%), T3a in 1 (6.7%), T3b in 7 (46.7%) and T3c in 6 (50%) patients. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group. Weight loss and reduced inflammation by TTh may have contributed to our findings.

Prostate cancer (PCa) incidence and severity in 821 hypogonadal men with and without testosterone therapy (TTh) in a controlled, observational registry implying more than 7,000 patient-years.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 304-304
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider
Keyword(s):  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Observation Time ◽  
Group 12 ◽  
The Mean ◽  
Age Range ◽  
Treatment Observation

304 Background: Guidelines by AUA and EAU state that there is no evidence for an increased PCa risk for testosterone (T) treatment in hypogonadal men. Methods: In a registry study initiated in 2004 in a urology practice, 428 hypogonadal men (T≤350 ng/dL) received T undecanoate 1000 mg every 3 months following an initial 6-month interval for up to 13 years (T-group). 393 hypogonadal men (age range 51-74) opted against TTh (CTRL). Suspicion of or active PCa was excluded by transrectal ultrasound, digital rectal examination and PSA before treatment/observation initiation. Examinations were repeated between one and four times per year. Biopsies were performed when indicated according to EAU Guidelines. Results: In the T-group, 12 (2.8%) , in CTRL, 42 men (10.9%) were diagnosed with PCa. The mean baseline age of PCa patients was 64.9 years in the T-group and 64 in CTRL.In the T-group, the average time span between day of first injection and positive biopsy was 14.2 months (range: 5-18). No patient was diagnosed with PCa beyond 18 months of TTh. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy (RP) was performed in all men. All but 3 patients had Gleason score (GS) ≤6, and all but 1 had a primary GS of 3. Tumor grade was G2 in all 12 (100%), tumor stage T2a in 7 (58%), T2b in 3 (25%), and T2c in 2 (17%) patients. All but 2 patients are back on TTh after an average time of 25 months. In CTRL, RP was performed in all but 6 patients who received radiation therapy (RT). GS was ≤6 in 2 patients, 7 men had a GS of 7, 21 a GS of 8, and 12 a GS of 9. 4 men had a primary Gleason score of 3, 29 had 4, and 9 had 5. Tumor grade was G2 in 9 (21%) and G3 in 33 (79%) patients, tumor stage T2a in 2 (5%), T2c in 1 (2%), T3b in 15 (36%) and T3c in 24 (57%) patients. In CTRL, biochemical recurrence occurred in 11 (26%) patients. These patients received androgen deprivation therapy (ADT). 12 (34%) patients died of whom 7 were on ADT. In the T-group, no biochemical recurrences or deaths occurred during the observation time. Conclusions: Less PCa occurred and severity was lower in testosterone-treated hypogonadal patients compared to untreated hypogonadal controls.

Prostate cancer in 671 hypogonadal men with and without long-term testosterone treatment: Results from a controlled registry study.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 33-33
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider
Keyword(s):  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Control Group ◽  
Testosterone Undecanoate ◽  
Reactive Protein ◽  
Age Range

33 Background: Despite persisting concerns, there is no evidence that TTh in men with hypogonadism increases PCa incidence or severity. Rather, a Canadian group recently found that long-term TTh decreased the risk of PCa diagnosis (Wallis et al., Lancet Diab Endocrinol 2016; 4:498). We assessed incidence and severity of PCa in hypogonadal men on long-term TTh (T-group) in comparison to an untreated hypogonadal control group (CTRL). Methods: 375 men (age range: 33-70) with testosterone ≤ 350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 10 years. 296 hypogonadal men (57-74) opted against TTh. Median follow-up: 7 years. Prostate volume (PV), PSA, weight and C-reactive protein (CRP) were measured and digital rectal examination/transrectal ultrasound performed before treatment initiation and then regularly every 3-6 months. Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, PV increased slightly but significantly by 2.41 mL (p < 0.0001), PSA by 0.22 (NS). In CTRL, PV decreased slightly but significantly by -1.20 mL (p < 0.005), PSA by -0.38 (p < 0.0001). Weight dropped by 18.23% in the T-group and increased by 1.78% in CTRL, CRP decreased significantly in the T-group and remained unchanged in CTRL. In the T-group, 8 men (2.1%) were diagnosed with PCa. In CTRL, 12 (4.1%) were diagnosed with PCa. The incidence per 10,000 years was 32 in the T-group and 64 in CTRL. The mean baseline age of PCa patients was 65 years in both groups. Prostatectomy was performed in all men. In the T-group, all patients had a Gleason score ≤ 6 and a predominant Gleason score of 3. Tumor grade was G2 in all 8 (100%), tumor stage T2a in 6 (75%) and T2b in 2 (25%) patients. In CTRL, Gleason score was > 6 in all 12 patients. Three men had a predominant Gleason score of 3, 8 had 4, and 1 had 5. Tumor grade was G2 in 5 (41.7%) and G3 in 7 (58.3%) patients, tumor stage T2b in 1 (8.3%), T2c in 1 (8.3%), T3b in 4 (33.3%) and T3c in 6 (50%) patients. Conclusions: TTh in hypogonadal men regularly monitored may decrease incidence of PCa compared to hypogonadal CTRL. PCa was less severe in the T-group. Weight loss and reduced inflammation by TTh may have contributed to our findings.

Stability in Waking-Sleep States in Neonates as a Predictor of Long-Term Neurologic Outcome

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 52-63
Author(s):  
Cesare T. Lombroso ◽  
Yoichi Matsumiya
Keyword(s):  
Statistical Significance ◽  
Observation Time ◽  
Long Term Outcomes ◽  
Newborn Period ◽  
Waking And Sleep ◽  
Total Observation Time ◽  
Total Observation ◽  
The Individual

Thirty-three full-term neonates were ranked blindly on a scale ranging from the least to the highest "risk" for future neurologic complications on the basis of available perinatal biographies, tests, and examinations performed during the newborn period. Four prolonged polygraphic-behavioral recordings were obtained one week apart beginning at ten days after birth. Five waking and sleep states were scored in each session as percentages of total observation time, giving a total of 20 scores for each baby to be subjected to analysis of variance. These measures also provided individual profile consistency or variability in maintaining waking-sleep states over the selected period of postnatal time. The whole cohort, except three infants who could not be followed adequately, was then reexamined periodically over a period ranging from 3 to 4 years (±6 months) for neurologic and developmental assessments. Except for two scores that produced a low level of statistical significance (P &lt; .05), the other 18 scores were found to be not associated with long-term outcomes. Even the first two scores were not satisfactory discriminators for the outcome of the individual babies. However, when coefficients of concordance (W) were computed from each individual baby profile, significant statistics (P &lt; .001) emerged to indicate good correlations between high or low W values in the newborn period and long-term outcomes. All 17 newborns who had W scores greater than 0.9 were found to be normal at follow-up regardless of the poor ranking given several of them during the newborn period. Among the 13 newborns who had W scores less than 0.9, 11 had a poor clinical outcome at follow-up, though several had been ranked initially as falling within the least "risk" group.

scholarly journals Recurrence of Cholesteatoma - A Retrospective Study Including 1,006 Patients for More than 33 Years

2019 ◽  
Vol 24 (01) ◽  
pp. e18-e23 ◽  
Author(s):  
Patrick Rønde Møller ◽  
Christina Nygaard Pedersen ◽  
Line R. Grosfjeld ◽  
Christian E. Faber ◽  
Bjarki D. Djurhuus
Keyword(s):  
Middle Ear ◽  
Total Sample ◽  
Observation Time ◽  
Benign Tumors ◽  
Retraction Pocket ◽  
Risk Of Recurrence ◽  
Middle Ear Cholesteatoma ◽  
Total Observation Time ◽  
Total Observation ◽  
First Time

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle-ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years.The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2–3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

scholarly journals The effects of introducing the Amazonian squirrel monkey on the behavior of the northeast marmoset

2015 ◽  
Vol 45 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Fátima Luciana Miranda CAMAROTTI ◽  
Valdir Luna da SILVA ◽  
Maria Adélia Borstelmann de OLIVEIRA
Keyword(s):  
Squirrel Monkey ◽  
Native Species ◽  
Callithrix Jacchus ◽  
Observation Time ◽  
Saimiri Sciureus ◽  
Significant Difference ◽  
Negative Effect ◽  
Total Observation Time ◽  
Total Observation ◽  
The Impact

The squirrel monkey Saimiri sciureus, an endemic primate of the Amazonian Basin, has been introduced in many localities of the Atlantic Forest biome. Introduced exotic species gain a competitive advantage in their new environment because of a lack of natural predators, competitors or diseases. This advantage can result in a reduction in the resources for the endemic species. The aims of this work were to evaluate the level of adaptation, and monitor the forms of interaction and the impact caused by S. sciureus on the behavior of the native species Callithrix jacchus in the Saltinho Biological Reserve, Tamandaré, Pernambuco, Brazil. The behavior was assessed by use of scan sampling method, every 5 min. A total of 382 h (191 h or 2,292 scans per group) of time sampling was performed. Sixteen interactions were recorded. The interaction index was low and represented 2.4% of the total observation time. Interactions were significantly higher during the dry season (58.5%) relative to the rainy season (41.5%). Callithrix jacchus was intolerant to the presence of S. sciureus and the last one was more tolerant during the interactions. In the presence of S. sciureus, C. jacchus eating, foraging, resting, socializing, and self-grooming behaviors were reduced while alertness was increased. Territorial behavior showed no significant difference. In the presence of S. sciureus, on average, the group of marmosets assembled at a higher layer of the forest stratum. The results might indicate a negative effect of S. sciureus on the native species, C. jacchus.

scholarly journals Urinary PSA level and relative tumor volume after prostate biopsy

2009 ◽  
Vol 56 (2) ◽  
pp. 17-21 ◽  
Author(s):  
T. Pejcic ◽  
J. Hadzi-Djokic ◽  
B. Markovic ◽  
D. Dragicevic ◽  
B. Glisic ◽  
...  
Keyword(s):  
Gleason Score ◽  
Prostate Biopsy ◽  
Tumor Volume ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Preoperative Assessment ◽  
Tumor Grade ◽  
Peripheral Zone ◽  
Tumor Infiltration ◽  
Tumor Biopsy

Objectives: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. Methods: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS) - guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound- derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. Results: Average uPSA was 308.6+311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7+ 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7+ 0.8, Gleason score 5.2 + 1.3, the percentage of tumor infiltration 27.6+21.8 %, and the percentage of positive cores, 52.2+30.7 %. Average RTV was 6.3+ 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 0.6 vs. 2.1+0.8, p=0.0002), lower GS (4.5+1 vs. 5.8+1.3, p=0.003) and higher uPSA (389.4+340.8 vs. 193.1 +229.7, p=0.014). There were no differences in serum PSA levels between the groups. Conclusion: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.

scholarly journals A decadal cirrus clouds climatology from ground-based and spaceborne lidars above the south of France (43.9° N–5.7° E)

2013 ◽  
Vol 13 (14) ◽  
pp. 6951-6963 ◽  
Author(s):  
C. Hoareau ◽  
P. Keckhut ◽  
V. Noel ◽  
H. Chepfer ◽  
J.-L. Baray
Keyword(s):  
Observation Time ◽  
Cirrus Clouds ◽  
Cirrus Cloud ◽  
Upper Troposphere ◽  
Cloud Parameters ◽  
Cloud Properties ◽  
Total Observation Time ◽  
The Mean ◽  
Ground Based Lidar ◽  
Total Observation

Abstract. This study provides an analysis of cirrus cloud properties at midlatitude in the southern part of France from ground-based and spaceborne lidars. A climatology of cirrus cloud properties and their evolution over more than 12 yr is presented and compared to other mid-latitude climatological studies. Cirrus clouds occur ~37% of the total observation time and remain quasi-constant across seasons with a variation within ~5% around the mean occurrence. Similar results are obtained from CALIOP and the ground-based lidar, with a mean difference in occurrence of ~5% between both instruments. From the ground-based lidar data, a slight decrease in occurrence of ~3% per decade is observed but found statistically insignificant. Based on a clustering analysis of cirrus cloud parameters, three distinct classes have been identified and investigations concerning their origin are discussed. Properties of these different classes are analysed, showing that thin cirrus in the upper troposphere represent ~50% of cloud cover detected in summer and fall, decreasing by 15–20% for other seasons.

Phase III results of adjuvant radiotherapy (RT) versus wait-and-see (WS) in patients with pT3 prostate cancer following radical prostatectomy (RP)(ARO 96–02/AUO AP 09/95)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5060-5060 ◽  
Author(s):  
T. Wiegel ◽  
D. Bottke ◽  
N. Willich ◽  
H. Piechota ◽  
A. Siegmann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Adjuvant Radiotherapy ◽  
Progressive Disease ◽  
Hormonal Treatment ◽  
Tumor Stage ◽  
Phase Iii ◽  
Phase Iii Study

5060 Background: Adjuvant RT for pT3 R1 or R0 patients (pts.) after RP remains controversial. Results of an EORTC-phase-III- study (with unknown PSA-status after RP) suggested a 20% better biochemical control (bNED) after 5 years for RT. Methods: 385 men with prostate cancer were randomized to either 60 Gy RT (arm A; n=193) or WS (arm B; n=192) before achieving an undetectable PSA. Pts. were stratified for Gleason-score, margin status, neoadjuvant hormonal treatment and stage (pT3A+B vs. C). When the undetectable PSA-level after RP was not achieved, the pts. were stated as progressive disease and left arm A/B and were irradiated. PSA-progression for pts. with undetectable PSA was stated after two consecutive increasing PSA out of the undetectable range. Primary endpoint was bNED. Study was powered to demonstrate a 15% increase in bNED for RT. Results: 78 pts. (20%) did not achieve an undetectable PSA and were stated as progressive disease (arm A: 45 pts., arm B: 33 pts.). Additionally, 34 pts. (23%) from the RT-arm did not receive RT. Therefore, 114 pts. had RT (arm A) and 159 pts. WS (arm B). Median follow up was 53.6 months for arm A and 53.7 months for arm B. BNED at 5 years increased to 72% for arm A (RT) compared with 54% for arm B (WS) (p=0.0015, hazard ratio 0.53). Pts. with a preop. PSA > 10 ng/ml, tumor stage =pT3b, Gleason score =8 as well as positive margins profited significantly from adjuvant RT. The rate of late grade II side effects for the rectum was 1%. Conclusions: Adjuvant radiotherapy for pT3 prostate cancer significantly reduces the risk of biochemical progression after radical prostatectomy. The rate of side effects is very low. No significant financial relationships to disclose.

The impact of comorbidity on survival among men with localized prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 8-8 ◽  
Author(s):  
G. L. Lu-Yao ◽  
D. Moore ◽  
W. Shih ◽  
Y. Lin ◽  
H. Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Localized Prostate Cancer ◽  
Medicare Program ◽  
Co Morbidity ◽  
Underlying Causes ◽  
Morbidity Index ◽  
The Impact

8 Background: To provide patients and clinicians more accurate estimates of co-morbidity specific survival stratified by patient age, tumor stage and tumor grade. Methods: We conducted a ten year competing risk analysis of 19,639 men age 66 years and older identified by the Surveillance, Epidemiology and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and co-morbidity at diagnosis classified using the Charlson co-morbidity index. Underlying causes of death were obtained from SEER. Results: During the first ten years following diagnosis men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. For men age 66-74 years with stage T1c Gleason score 5-7 disease at diagnosis, ten year overall mortality rates and prostate cancer specific rates were 28.8%, 50.5%, 83.1% and 4.8%, 2.0%, 5.3% respectively for men with Charlson scores 0, 1 and > 2. For men age 66-74 years with T1c Gleason score 8-10 disease at diagnosis, the corresponding rates were 55.0%, 52.0%, 64.3% and 25.7%, 20.2%, 13.7% respectively for men with Charlson scores 0, 1, > 2. Death from competing medical hazards was roughly comparable for men with stage T2 disease and higher for all men over age 75. Conclusions: Patients and clinicians should consider using co-morbidity specific data to estimate the threat posed by localized prostate cancer. No significant financial relationships to disclose.

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