Assessment of 2,000 patients presenting to a multidisciplinary prostate cancer clinic in the United Kingdom.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5077-5077
Author(s):  
Pandora Rudd ◽  
John Hines ◽  
Eleanor Watkins ◽  
Thomas Powles ◽  
Karen Tipples
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Disease Severity ◽  
Active Surveillance ◽  
Group Treatment ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Choice ◽  
Low Risk ◽  
High Risk Disease

5077 Background: Multidisciplinary clinics (MDCs) involving both oncologists and urologists are recommended for managing radical prostate cancer patients. The effectiveness of MDCs in arriving at best treatment decisions is unknown. We analysed patient characteristics and management decisions over 8 years in a MDC at Bart’s Hospital, London. Methods: Clinical data were collected in real time and analysed retrospectively, including demographics, tumour stage and grade, D’amico risk group, treatment choice and first clinician seen. We compared variables in 1000 consecutive patients presenting between 2011-2015 (cohort A) to 1000 patients presenting 2016-18 (cohort B) to investigate trends over time. Results: 2000 patients were included, age 65.2 ± 8.6 years and 65.9 ± 9.1 years (p=0.08), with presenting PSA 9.0 (6.3-14.4) and 9.2 (6.4-15.0) ng/ml (p=0.36), in cohort A and B respectively. Disease severity and initial treatment decision are shown in the table. In low risk disease, 126 (75%) patients had active surveillance in cohort A, and 158 (90%) in cohort B (p=0.0003). In high risk disease, 202 (59%) patients had radiotherapy compared to 194 (50%) in cohort B (p=0.011). In cohort B, 127 (39%) patients seeing oncology first had radiotherapy compared to 143 (25%) patients who saw urology first (p<0.0001). 76 (23%) and 154 (27%) patients had surgery, that saw oncology and urology first, respectively (p=0.11). Conclusions: In 2000 patients presenting to a prostate MDC over 8 years, active surveillance in low risk disease increased, radiotherapy in high risk disease reduced, and the proportion undergoing surgery was unchanged. The initial clinician seen influenced treatment choice; having both specialists in the same consultation may improve consistency of treatment decisions. Disease severity and treatment choice before and after 2016. [Table: see text]

Active surveillance for early stage prostate cancer: What do men and their partners think?

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 95-95
Author(s):  
Jinping Xu ◽  
Arun Mallapareddi ◽  
Julie Ruterbusch ◽  
Elyse Reamer ◽  
Susan Eggly
Keyword(s):  
Prostate Cancer ◽  
Focus Groups ◽  
Active Surveillance ◽  
Early Stage ◽  
Treatment Decision ◽  
Low Risk ◽  
Physical And Mental Health ◽  
Current Function ◽  
Physician Trust ◽  
Qualitative Thematic Analysis

95 Background: Despite growing recognition over the last decade that active surveillance (AS) is a reasonable management option for men diagnosed with localized prostate cancer (LPC), only a minority of men choose AS. This study examines the conceptualizations, experiences, and reasons for choosing AS among men with LPC and their partners. Methods: We conducted three focus groups with men with LPC who had chosen AS (7 black, 5 white) and two focus groups with their partners (all women, 2 black, 4 white). Men were identified from a cancer registry or from an academic urologists’ practice. Focus groups were video/audio recorded, transcribed and analyzed using qualitative thematic analysis. Results: Men’s median time on AS was 18 months (range 6-72) and median age was 61 years (range 47-71). Men used many different terms (mostly “wait and see”) to describe similar AS protocols. AS was seen as delaying unnecessary treatment and keeping current function with curable treatment available later if needed. Black men mentioned concerns that some physicians profit by providing unnecessary treatments. Reasons for choosing AS included seeing their cancer as “small” or “low-risk” and trusting their physician’s advice/monitoring, despite reported concerns about PSA being an unreliable test and painful biopsies. Men recognized, but were comfortable with, the small but real threat their cancer could grow. Men found they had to justify their choice to other family members, even when their partners were supportive. Partners saw themselves as very involved and influential in the treatment decision. They were comfortable with AS because of their trust in physicians. Partners believed they know their husband’s physical and mental health better than the men themselves. Conclusions: Physician trust and description of the cancer as low-risk were the most cited reasons for adopting AS. Emphasizing the low-risk nature of the cancer and enhancing physician trust may increase the acceptability of AS.

scholarly journals PD55-01 ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER AMONG MEN WITH HIGH RISK GENETIC PREDISPOSITION

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Daniel Halstuch* ◽  
Chen shenar ◽  
Sivan Sela ◽  
Yaara Ber ◽  
Daniel Kedar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Active Surveillance ◽  
Genetic Predisposition ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

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.

Are men with favorable intermediate-risk prostate cancer candidates for active surveillance?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 82-82
Author(s):  
Ann Caroline Raldow ◽  
Danjie Zhang ◽  
Ming-Hui Chen ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Active Surveillance ◽  
Locally Advanced ◽  
Low Risk ◽  
P Value ◽  
High Dose ◽  
Intermediate Risk ◽  
Increased Risk ◽  
Risk Prostate Cancer

82 Background: Active surveillance (AS) is considered appropriate for patients with low-risk prostate cancer (PC) and a life expectancy of at least 10 years. However, with grade migration following the 2005 International Society of Urologic Pathology consensus conference, AS may also be an initial option for men with favorable intermediate-risk PC. We estimated and compared the risk of PC-specific mortality (PCSM) following high dose radiation therapy and androgen deprivation therapy as appropriate amongst men with low, favorable intermediate, unfavorable intermediate, and high-risk PC. Methods: The study consisted of 6,595 consecutively treated men (median age: 68 years) with localized or locally advanced PC at the Chicago PC Center between 1997 and 2013. Fine and Gray competing risks regression analyses (table) were used to assess the risk of PCSM in men with favorable intermediate, unfavorable intermediate or high-risk compared to low-risk PC, adjusting for age at and year of treatment. Results: After median follow-up of 7.76 years, 820 men died: 72 of PC. While men with favorable intermediate-risk did not have significantly increased risk of PCSM as compared to low-risk PC (adjusted hazard ratio (HR) 1.28, 0.63-2.62 95% confidence interval (CI), p-value 0.49), men with high (adjusted HR 9.91, 5.48-17.94 95% CI, p-value <0.0001) or unfavorable intermediate-risk PC (adjusted HR 3.17, 1.60-6.30, p-value 0.001) did. Eight-year point estimates of PCSM were low: 0.68% [0.32-1.31% 95% CI] and 0.44% [0.25-0.75% 95% CI] for men with favorable intermediate and low-risk PC, respectively. Conclusions: Men with low and favorable intermediate-risk PC have similar and low estimates of PCSM during the first decade following standard management. These results provide evidence to support AS as an initial approach for men with favorable intermediate-risk PC. [Table: see text]

Impact of genomic risk scores on treatment decisions following radical prostatectomy in a prospective Medicare registry.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 72-72
Author(s):  
John L. Gore ◽  
Darlene Dai ◽  
Robert Benjamin Den ◽  
Kasra Yousefi ◽  
Tiffany Le ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Treatment Decisions ◽  
Low Risk ◽  
Oncologic Outcomes ◽  
Risk Scores ◽  
Risk Patients ◽  
The Impact

72 Background: Prostate cancer patients and providers confront uncertainty as they consider adjuvant or salvage radiation therapy (ART, SRT) after radical prostatectomy (RP). We prospectively evaluated the impact of the Decipher RP test, which predicts metastasis risk after RP, on decision-making for postoperative radiation therapy. Methods: Between October 2016 and May 2017, 1,319 patients treated with RP and considering ART or SRT were enrolled into a Medicare Certification and Training Registry (CTR). Providers submitted a management recommendation based on initial clinical and pathology findings prior to obtaining the Decipher RP test and again upon receiving test results. Only Medicare patients that met the Local Coverage Determination inclusion criteria (i.e., non-organ confined prostate cancer or positive margins or rising PSA) and whose provider was certified in the CTR registry were included in the analysis. Results: Based on clinical variables alone, treatment was recommended for 26% of adjuvant and 19% of salvage patients. Obtaining a Decipher score, changed treatment recommendations in 34% (95% CI 30-39%) and 28% (95% CI 19-38%) of men considering adjuvant or salvage therapy respectively. Among men considering ART, 9% of Decipher low risk patients and 45% of Decipher high-risk patients were recommended treatment. Multivariable logistic regression demonstrated that – independent of pathology risk factors, a high-risk Decipher score was associated with an odds ratio of 7.3 (95% CI 3.9-14.2 p < 0.001) in the adjuvant and 5.5 (95% CI, 1.3-27.8, p = 0.026) in the salvage setting. Conclusions: A prospective CTR demonstrated that use of Decipher resulted in significant changes in treatment decisions for Medicare beneficiaries with PCa considering adjuvant and salvage therapies. Ongoing prospective studies aim at determining how increased use of therapy in men with high Decipher risk impacts oncologic outcomes and whether decreased use in Decipher low risk individuals improves health related quality of life without harming patient survival.

scholarly journals Prognostic Value of the LATITUDE and CHAARTED Risk Criteria for Predicting the Survival of Men with Bone Metastatic Hormone-Naïve Prostate Cancer Treated with Combined Androgen Blockade Therapy: Real-World Data from a Japanese Multi-Institutional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Takashi Kawahara ◽  
Shuko Yoneyama ◽  
Yoshio Ohno ◽  
Junpei Iizuka ◽  
Yasunobu Hashimoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
High Volume ◽  
Low Risk ◽  
Free Survival ◽  
Combined Androgen Blockade ◽  
Number Of Patients ◽  
High Risk Disease ◽  
Low Volume ◽  
Androgen Blockade

Background. The CHAARTED and LATITUDE trials demonstrated a prolonged overall survival (OS) for metastatic hormone-naïve prostate cancer (mHNPC) patients who receive up-front docetaxel or abiraterone acetate. These studies used their own risk criteria: CHAARTED trial defines high- and low-volume diseases and LATITUDE trial targeting a high-risk disease. The present study explored whether or not the CHAARTED and LATITUDE criteria were useful for predicting the outcome in Japanese bone mHNPC patients, including elderly patients (≥70 years). Methods. A total of 532 mHNPC patients diagnosed from 2004 to 2014 in multithird referral cancer centers were enrolled in this study. All patients had bone metastasis and received combined androgen blockade treatment as an initial hormonal therapy. Results. The number of patients with CHAARTED low-volume and high-volume diseases was 178 (33.5%) and 354 (66.5%), respectively. On the contrary, the number of patients with LATITUDE low-risk and high-risk diseases was 157 (29.5%) and 375 (70.5%), respectively. A total of 307 (57.7%) patients were defined as having both CHAARTED high-volume and LATITUDE high-risk disease. The median castration-resistant prostate cancer- (CRPC-) free survival was 12.5 months for the CHAARTED high volume, 56.9 months for the CHAARTED low volume, 13.6 months for the LATITUDE high risk, and 37.3 months for the LATITUDE low risk, respectively. The OS was 50.1 months in patients with CHAARTED high-volume disease, 95.1 months in patients with CHAARTED low-volume disease, 54.0 months in patients with LATITUDE high-risk disease, and 92.7 months in patients with LATITUDE low-risk disease, respectively. This trend was also observed in elderly (≥70 years old) patients. Conclusions. The patients with CHAARTED high-volume disease or LATITUDE high-risk disease showed a shorter CRPC-free survival and a shorter OS than those in the CHAARTED low-volume disease group or in the LATITUDE low-risk group among Asian Japanese bone metastatic HNPC patients.

Prostate cancer in the British Asian population: A case-control study

2020 ◽  
pp. 205141582096957
Author(s):  
Luke R Forster ◽  
Clare Jelley ◽  
Charles E Breeze ◽  
Rajindra Singh ◽  
Rohit Chahal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Active Surveillance ◽  
Asian Population ◽  
Short Term ◽  
Disease Characteristics ◽  
Co Morbidity ◽  
High Risk Disease ◽  
Caucasian Patients ◽  
Control Study

Objectives: To study demographic and disease variables at presentation, diagnosis and treatment of prostate cancer in British South Asian (SA) men and compare with their Caucasian counterparts. Methods: A retrospective review of prostate cancer cases between 2010 and 2015 identified patients of SA descent who were matched for age, residential location and year of diagnosis with two Caucasian patients. Disease characteristics, treatment and short-term outcomes were recorded and compared. Results: A total of 1274 patients were diagnosed, of which 50 (3.9%) were SA. SA patients had less screen-detected prostate cancer (12% versus 31%, p=0.02), more co-morbidity and more high-risk disease (57% versus 37%, p=0.03). Active surveillance was the preferred treatment option (32%) with 2% having surgery compared with 22% ( p=0.003) from the Caucasian cohort. Logistic regression showed these disparities to be related to the different presentations. Conclusion: SA men with prostate cancer are less likely to be diagnosed following asymptomatic screening and the majority have high-risk disease at presentation. These differences lead to SA men preferring active surveillance to radical surgery. Given the increasing British Asian population, the findings demonstrate a need for research and public health interventions to better understand and address the differences noted between these groups.

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.

scholarly journals Active surveillance for low-risk localized prostate cancer: what do men and their partners think?

2016 ◽  
Vol 34 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Arun Mallapareddi ◽  
Julie Ruterbusch ◽  
Elyse Reamer ◽  
Susan Eggly ◽  
Jinping Xu
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Specific Antigen ◽  
Treatment Decision ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
Low Grade ◽  
Management Option ◽  
Prostate Biopsies

Abstract Background. Active surveillance (AS) is recognized as a reasonable treatment option for low-risk localized prostate cancer (LPC) but continues to be chosen by a minority of men. To date, limited data are available regarding reasons why men with low-risk LPC adopt AS. Purpose. The aim of this study is to better understand conceptualizations, experiences and reasons why men with low-risk LPC and their partners adopt AS. Methods. We conducted five focus groups (FGs), three among men with low-risk LPC who had chosen AS and two with their partners. FGs were video/audio recorded, transcribed and analysed using qualitative thematic analysis. Results. A total of 12 men and 6 partners (all women) participated in FG discussions. The most common reasons for choosing AS were seeing the LPC as ‘small’ or ‘low grade’ without need for immediate treatment and trusting their physician’s AS recommendation. The most common concerns about AS were perceived unreliability of prostate specific antigen, pain associated with prostate biopsies and potential cancer progression. Partners saw themselves as very involved in their husbands’ treatment decision-making process, more than men acknowledged them to be. Multiple terms including ‘watchful waiting’ were used interchangeably with AS. There appeared to be a lack of understanding that AS is not simply ‘doing nothing’ but is actually a recognized management option for low-risk LPC. Conclusions. Emphasizing the low risk of a man’s LPC and enhancing physician trust may increase acceptability of AS. Standardizing terminology and presenting AS as a reasonable and recognized management option may also help increase its adoption.

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