Adverse pathology as a predictor of distant metastasis and prostate cancer mortality with 20-year follow up.

219 Background: Adverse pathology (AP) at radical prostatectomy (RP) is often used as a proxy for long-term prostate cancer outcomes. The goal of this study was to assess the association of AP at RP, defined as high-grade (> Grade Group 3) and/or non-organ confined disease (pT3), with distant metastasis and prostate cancer death. Methods: A stratified cohort sample of 428 patients was used to evaluate the association of adverse pathology with the risk of distant metastases and prostate cancer-specific mortality over 20 years after prostatectomy in 2641 patients treated between 1987-2004. Cox regression of cause-specific hazards was used to estimate the absolute risk of both endpoints, with death from other causes treated as a competing risk. Subgroup analysis in patients with low/intermediate risk disease potentially eligible for active surveillance was performed. Results: Among the 428 patients, 343 had AUA Low or Intermediate risk disease and 85 had High risk disease. Median follow-up time was 15.5 years (IQR 14.6–16.6 years). Using the cohort sampling weights for estimation, at RP 29.8% of patients had high-grade disease, 42.3 % had non-organ confined disease, 19.3% had both, and thus 52.8% had AP. Adverse pathology was highly associated with metastasis and prostate cancer mortality in the overall cohort (HR 12.30, 95% CI 5.30-28.55, and 10.03, 95% CI 3.42-29.47, respectively, both p<0.001), and in the low/intermediate risk subgroup potentially eligible for active surveillance (HR 10.48, 95% CI 4.18-26.28, and 8.60, 95% CI 2.40-30.84, respectively, both p≤0.001). Conclusions: Adverse pathology at radical prostatectomy is highly associated with future development of metastasis and prostate cancer mortality and may be used as a short-term predictor of outcomes. [Table: see text]

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Radical Prostatectomy Versus Observation in Early Prostate Cancer

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0006 ◽

2021 ◽

pp. 31-36

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Cancer Mortality ◽

Watchful Waiting ◽

Specific Antigen ◽

Prostate Cancer Mortality ◽

Cancer Group

This chapter provides a summary of the landmark Scandinavian Prostate Cancer Group Study Number 4 trial of men with clinically localized prostate cancer from the pre–prostate-specific antigen (PSA) era who were randomized to radical prostatectomy versus watchful waiting and were followed long term. With follow-up of more than 20 years, the results favored surgery with regard to prostate cancer mortality.

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Prostate Cancer Mortality following Active Surveillance versus Immediate Radical Prostatectomy

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-12-1502 ◽

2012 ◽

Vol 18 (19) ◽

pp. 5471-5478 ◽

Cited By ~ 42

Author(s):

Jing Xia ◽

Bruce J. Trock ◽

Matthew R. Cooperberg ◽

Roman Gulati ◽

Steven B. Zeliadt ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Cancer Mortality ◽

Prostate Cancer Mortality

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Validating the Association of Adverse Pathology with Distant Metastasis and Prostate Cancer Mortality 20-Years After Radical Prostatectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.10.005 ◽

2021 ◽

Author(s):

Michael A. Brooks ◽

Lewis Thomas ◽

Cristina Magi-Galluzzi ◽

Jianbo Li ◽

Michael R. Crager ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Distant Metastasis ◽

Cancer Mortality ◽

Prostate Cancer Mortality

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Aspirin use in prostate cancer and the risk of death and metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1518 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1518-1518 ◽

Cited By ~ 1

Author(s):

Jonathan Assayag ◽

Laurent Azoulay ◽

Hui Yin ◽

Michael N. Pollak ◽

Samy Suissa

Keyword(s):

Prostate Cancer ◽

Cancer Diagnosis ◽

Distant Metastasis ◽

Cancer Mortality ◽

Control Analysis ◽

Cancer Outcomes ◽

Prostate Cancer Diagnosis ◽

Prostate Cancer Mortality ◽

All Cause Mortality

1518 Background: There has been recent interest in the role of aspirin in preventing prostate cancer outcomes, but data remain limited. The objective was to determine whether the use of aspirin after prostate cancer diagnosis is associated with a decreased risk of prostate cancer mortality, distant metastasis and all-cause mortality in men newly-diagnosed with prostate cancer. Methods: A population-based cohort of men diagnosed with non-metastatic prostate cancer between 01/04/1998 and 31/12/2009 was identified using the UK Clinical Practice Research Datalink, including the Cancer Registry. All men were followed until death, distant metastasis, or 01/10/2012. A nested case-control analysis was performed where, for each case with an incident outcome event, up to 10 controls were matched on age, year of diagnosis and duration of follow-up. Exposure was defined as aspirin use during the matched follow-up period. Rate ratios (RR) and 95% confidence intervals (CI) were estimated using conditional logistic regression, adjusted for covariates and considering effect modification by aspirin use prior to prostate cancer diagnosis. Results: The cohort included 13,396 prostate cancer patients, followed for 3.9 (SD=2.4) years during which 4,425 deaths occurred, including 2,315 from prostate cancer, and 2,344 cases of distant metastasis. Aspirin use was associated with an increased risk of prostate cancer mortality (RR 1.36, 95% CI 1.18-1.55) and all-cause mortality (RR 1.33, 95% CI 1.21-1.47), but not distant metastasis (RR 1.09, 95% CI 0.94-1.27). The increased risks were limited to patients who did not use aspirin before diagnosis, for both prostate cancer mortality (RR 1.69, 95% CI 1.43-2.00) and all-cause mortality (RR 1.62, 95% CI 1.44-1.82), while those who used aspirin before diagnosis did not have increased risks (RR 0.93, 95% CI 0.76-1.15 and RR 0.98, 95% CI 0.85-1.13, respectively). Conclusions: The use of aspirin after prostate cancer diagnosis is not associated with a decreased risk of prostate cancer outcomes. Although increased risks were observed for all-cause and prostate cancer mortality, these effects were exclusively driven by new-users of aspirin, suggesting that aspirin use in these patients was likely related to disease progression.

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Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.2180 ◽

2010 ◽

Vol 28 (1) ◽

pp. 126-131 ◽

Cited By ~ 786

Author(s):

Laurence Klotz ◽

Liying Zhang ◽

Adam Lam ◽

Robert Nam ◽

Alexandre Mamedov ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Cancer Mortality ◽

Doubling Time ◽

Localized Prostate Cancer ◽

Definitive Treatment ◽

Prostate Cancer Mortality ◽

Psa Doubling Time ◽

Psa Failure

Purpose We assessed the outcome of a watchful-waiting protocol with selective delayed intervention by using clinical prostate-specific antigen (PSA), or histologic progression as treatment indications for clinically localized prostate cancer. Patients and Methods This was a prospective, single-arm, cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a PSA doubling time of less than 3 years, Gleason score progression (to 4 + 3 or greater), or unequivocal clinical progression. Survival analysis and Cox proportional hazard model were applied to the data. Results A total of 450 patients have been observed with active surveillance. Median follow-up was 6.8 years (range, 1 to 13 years). Overall survival was 78.6%. The 10-year prostate cancer actuarial survival was 97.2%. Overall, 30% of patients have been reclassified as higher risk and have been offered definitive therapy. Of 117 patients treated radically, the PSA failure rate was 50%, which was 13% of the total cohort. PSA doubling time of 3 years or less was associated with an 8.5-times higher risk of biochemical failure after definitive treatment compared with a doubling time of more than 3 years (P < .0001). The hazard ratio for nonprostate cancer to prostate cancer mortality was 18.6 at 10 years. Conclusion We observed a low rate of prostate cancer mortality. Among the patients who were reclassified as higher risk and who were treated, PSA failure was relatively common. Other-cause mortality accounted for almost all of the deaths. Additional studies are warranted to improve the identification of patients who harbor more aggressive disease despite favorable clinical parameters at diagnosis.

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Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort

Journal of Clinical Oncology ◽

10.1200/jco.2015.66.2361 ◽

2016 ◽

Vol 34 (32) ◽

pp. 3880-3885 ◽

Cited By ~ 15

Author(s):

Eric J. Jacobs ◽

Rebecca L. Anderson ◽

Victoria L. Stevens ◽

Christina C. Newton ◽

Ted Gansler ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Cancer Mortality ◽

The United States ◽

Cox Proportional Hazards ◽

High Grade ◽

Prostate Cancer Incidence ◽

Prostate Cancer Mortality ◽

Incidence And Mortality

Purpose In a recent large prospective study, vasectomy was associated with modestly higher risk of prostate cancer, especially high-grade and lethal prostate cancer. However, evidence from prospective studies remains limited. Therefore, we assessed the associations of vasectomy with prostate cancer incidence and mortality in a large cohort in the United States. Patients and Methods We examined the association between vasectomy and prostate cancer mortality among 363,726 men in the Cancer Prevention Study II (CPS-II) cohort, of whom 7,451 died as a result of prostate cancer during follow-up from 1982 to 2012. We also examined the association between vasectomy and prostate cancer incidence among 66,542 men in the CPS-II Nutrition Cohort, a subgroup of the CPS-II cohort, of whom 9,133 were diagnosed with prostate cancer during follow-up from 1992 to 2011. Cox proportional hazards regression modeling was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Results In the CPS-II cohort, vasectomy was not associated with prostate cancer mortality (HR, 1.01; 95% CI, 0.93 to 1.10). In the CPS-II Nutrition Cohort, vasectomy was not associated with either overall prostate cancer incidence (HR, 1.02; 95% CI, 0.96 to 1.08) or high-grade prostate cancer incidence (HR, 0.91; 95% CI, 0.78 to 1.07 for cancers with Gleason score ≥ 8). Conclusion Results from these large prospective cohorts do not support associations of vasectomy with either prostate cancer incidence or prostate cancer mortality.

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Faculty Opinions recommendation of Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717992427.793473599 ◽

2013 ◽

Author(s):

Jean Pierre Droz ◽

Helen Boyle

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Biochemical Recurrence ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Development and Validation of an Interpretable Artificial Intelligence Model to Predict 10-Year Prostate Cancer Mortality

Cancers ◽

10.3390/cancers13123064 ◽

2021 ◽

Vol 13 (12) ◽

pp. 3064

Author(s):

Jean-Emmanuel Bibault ◽

Steven Hancock ◽

Mark K. Buyyounouski ◽

Hilary Bagshaw ◽

John T. Leppert ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Treatment ◽

Cancer Mortality ◽

Treatment Strategies ◽

Gradient Boosting ◽

Prostate Cancer Treatment ◽

Prospective Data ◽

Prostate Cancer Mortality ◽

Development And Validation

Prostate cancer treatment strategies are guided by risk-stratification. This stratification can be difficult in some patients with known comorbidities. New models are needed to guide strategies and determine which patients are at risk of prostate cancer mortality. This article presents a gradient-boosting model to predict the risk of prostate cancer mortality within 10 years after a cancer diagnosis, and to provide an interpretable prediction. This work uses prospective data from the PLCO Cancer Screening and selected patients who were diagnosed with prostate cancer. During follow-up, 8776 patients were diagnosed with prostate cancer. The dataset was randomly split into a training (n = 7021) and testing (n = 1755) dataset. Accuracy was 0.98 (±0.01), and the area under the receiver operating characteristic was 0.80 (±0.04). This model can be used to support informed decision-making in prostate cancer treatment. AI interpretability provides a novel understanding of the predictions to the users.

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