scholarly journals A comparison of survival and mortality outcomes for older men with localized prostate cancer treated with either primary androgen deprivation therapy or primary observation

2019 ◽  
Author(s):  
Heikki Seikkula ◽  
Peter J. Boström ◽  
Karri Seppä ◽  
Janne Pitkäniemi ◽  
Nea Malila ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Propensity Score ◽  
Androgen Deprivation Therapy ◽  
Age Groups ◽  
Primary Treatment ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Hospital District ◽  
Specific Mortality

Abstract Background Androgen deprivation therapy (ADT) remains the primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment.Material and methods Finnish Cancer Registry data were utilized in this population-based study. Men aged > 70 years ( n =16534) diagnosed with localized PCa from 1985–2014, and treated either by primary observation or ADT in the absence of curative treatment, were included. The relative risk (RR) of PCa-specific mortality (PCSM) and other cause-specific mortality was determined. A life table for cause-specific survival (CSS) (i.e., PCa) and other-cause survival was created. Two age groups (70–79 years and > 80 years) and three time-based cohorts (1985–1994, 1995–2004, and 2005–2014) were compared following propensity score matching with four covariates (age, year of diagnosis, socioeconomic status, and hospital district). Follow-ups continued until death or 31 December 2015.Results PCSM risk was higher in men aged 70–79 years undergoing primary ADT compared to those managed with observation only (RR of 1.70, 95% confidence interval [CI]: 1.29–2.23 [1985–1994]; RR of 1.55, 95% CI: 1.35–1.84 [1995–2004]; and RR of 2.71, 95% CI: 2.08–3.53 [2005–2014]). Similar risk was observed in men aged > 80 years in two latest groups. Men in their 70s undergoing observation also had better propensity score-matched 10-year CSS than those undergoing ADT.Conclusion Conservative management is a valid option for patients with localized PCa in whom curative treatment is not possible.

scholarly journals Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation

2020 ◽  
Author(s):  
Heikki Seikkula ◽  
Peter J. Boström ◽  
Karri Seppä ◽  
Janne Pitkäniemi ◽  
Nea Malila ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Entire Study ◽  
Treatment Groups ◽  
Age Cohorts ◽  
Cancer Aggressiveness

Abstract Background: Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment.Methods: Men aged ≥70 years (n = 16534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70–79 years and ≥80 years) and three calendar time cohorts (1985–1994, 1995–2004, and 2005–2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. Results: Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70–79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29–2.23 [1985–1994]; RR 1.55, 95% CI: 1.35–1.84 [1995–2004]; and RR 2.71, 95% CI: 2.08–3.53 [2005–2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged >80 years; (p for age–period interaction = 0.237). Overall survival was also higher among men in their 70’s managed by observation compared to those undergoing ADT.Conclusions: Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study’s conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.

Androgen-deprivation therapy as primary treatment for localized prostate cancer

Cancer ◽  
2006 ◽  
Vol 106 (8) ◽  
pp. 1708-1714 ◽  
Author(s):  
Jun Kawakami ◽  
Janet E. Cowan ◽  
Eric P. Elkin ◽  
David M. Latini ◽  
Janeen DuChane ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Primary Treatment ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer

scholarly journals Influence of Baseline Cardiovascular Comorbidities on Mortality after Androgen Deprivation Therapy for Metastatic Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 189
Author(s):  
Szu-Yuan Wu ◽  
Su-Chen Fang ◽  
Olivia Rachel Hwang ◽  
Hung-Jen Shih ◽  
Yu-Hsuan Joni Shao
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Survival Benefit ◽  
Metastatic Prostate Cancer ◽  
Cox Model ◽  
Age Groups ◽  
Androgen Deprivation ◽  
Cardiovascular Comorbidities ◽  
Specific Mortality ◽  
The Status

Few studies have assessed the benefits of androgen deprivation therapy (ADT) in men with metastatic prostate cancer (PC; mPC) at an old age or with major cardiovascular conditions. A retrospective cohort consisted of 3835 men with newly diagnosed mPC from the Taiwan Cancer Registry of 2008–2014. Among them, 2692 patients received only ADT in the first year after the cancer diagnosis, and 1143 patients were on watchful waiting. The inverse probability of treatment-weighted Cox model was used to estimate the effects of ADT on all-cause mortality and PC-specific mortality according to age, and the status of congestive heart failure (CHF), coronary arterial diseases (CADs), and stroke at the baseline. After a median follow-up of 2.65 years, 1650 men had died. ADT was associated with a 17–22% risk reduction in all-cause and PC-specific mortality in men without stroke, CAD, or CHF in the 65–79-year group. The survival benefit diminished in men with any of these preexisting conditions. In contrast, ADT was not found to be associated with any survival benefit in the ≥80-year group, even though they did not present with any major cardiovascular disease at the baseline. Patients who had CHF, CAD, or stroke at the baseline did not show a survival benefit following ADT in any of the age groups. Men who have preexisting major cardiovascular diseases or are ≥80 years do not demonstrate a survival benefit from ADT for mPC. The risk–benefit ratio should be considered when using ADT for mPC in older men especially those with major cardiovascular comorbidities.

scholarly journals Effectiveness of Primary Androgen-Deprivation Therapy for Clinically Localized Prostate Cancer

2014 ◽  
Vol 32 (13) ◽  
pp. 1324-1330 ◽  
Author(s):  
Arnold L. Potosky ◽  
Reina Haque ◽  
Andrea E. Cassidy-Bushrow ◽  
Marianne Ulcickas Yood ◽  
Miao Jiang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Curative Intent ◽  
Primary Androgen Deprivation Therapy ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Primary Androgen Deprivation

Purpose Primary androgen-deprivation therapy (PADT) is often used to treat clinically localized prostate cancer, but its effects on cause-specific and overall mortality have not been established. Given the widespread use of PADT and the potential risks of serious adverse effects, accurate mortality data are needed to inform treatment decisions. Methods We conducted a retrospective cohort study using comprehensive utilization and cancer registry data from three integrated health plans. All men were newly diagnosed with clinically localized prostate cancer. Men who were diagnosed between 1995 and 2008, were not treated with curative intent therapy, and received follow-up through December 2010 were included in the study (n = 15,170). We examined all-cause and prostate cancer-specific mortality as our main outcomes. We used Cox proportional hazards models with and without propensity score analysis. Results Overall, PADT was associated with neither a risk of all-cause mortality (hazard ratio [HR], 1.04; 95% CI, 0.97 to 1.11) nor prostate-cancer–specific mortality (HR, 1.03; 95% CI, 0.89 to 1.19) after adjusting for all sociodemographic and clinical characteristics. PADT was associated with decreased risk of all-cause mortality but not prostate-cancer–specific mortality. PADT was associated with decreased risk of all-cause mortality only among the subgroup of men with a high risk of cancer progression (HR, 0.88; 95% CI, 0.78 to 0.97). Conclusion We found no mortality benefit from PADT compared with no PADT for most men with clinically localized prostate cancer who did not receive curative intent therapy. Men with higher-risk disease may derive a small clinical benefit from PADT. Our study provides the best available contemporary evidence on the lack of survival benefit from PADT for most men with clinically localized prostate cancer.

scholarly journals Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation

2019 ◽  
Author(s):  
Heikki Seikkula ◽  
Peter J. Boström ◽  
Karri Seppä ◽  
Janne Pitkäniemi ◽  
Nea Malila ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Entire Study ◽  
Treatment Groups ◽  
Age Cohorts ◽  
Cancer Aggressiveness

Abstract Background: Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. Methods: Men aged ≥70 years ( n = 16534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70–79 years and ≥80 years) and three calendar time cohorts (1985–1994, 1995–2004, and 2005–2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. Results: Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70–79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29–2.23 [1985–1994]; RR 1.55, 95% CI: 1.35–1.84 [1995–2004]; and RR 2.71, 95% CI: 2.08–3.53 [2005–2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged >80 years; ( p for age–period interaction = 0.237). Overall survival was also higher among men in their 70’s managed by observation compared to those undergoing ADT. Conclusions: Primary ADT is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study’s conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.

Androgen deprivation therapy as primary treatment for clinically localized prostate cancer: data from CaPSURE

Urology ◽  
2005 ◽  
Vol 66 (3) ◽  
pp. 4
Author(s):  
J. Kawakami ◽  
J. Cowan ◽  
E.P. Elkin ◽  
D.M. Latini ◽  
J. DuChane ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Primary Treatment ◽  
Androgen Deprivation ◽  
Localized Prostate Cancer ◽  
Cancer Data

scholarly journals Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials

2021 ◽  
Author(s):  
Tommy Jiang ◽  
Daniela Markovic ◽  
Jay Patel ◽  
Jesus E. Juarez ◽  
Ting Martin Ma ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Androgen Deprivation Therapy ◽  
Dose Escalation ◽  
Low Dose ◽  
Androgen Deprivation ◽  
Phase Iii ◽  
Localized Prostate Cancer ◽  
Treatment Intensification ◽  
Meta Regression

Abstract Background While multiple randomized trials have evaluated the benefit of radiation therapy (RT) dose escalation and the use and prolongation of androgen deprivation therapy (ADT) in the treatment of prostate cancer, few studies have evaluated the relative benefit of either form of treatment intensification with each other. Many trials have included treatment strategies that incorporate either high or low dose RT, or short-term or long-term ADT (STADT or LTADT), in one or more trial arms. We sought to compare different forms of treatment intensification of RT in the context of localized prostate cancer. Methods Using preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines, we collected over 40 phases III clinical trials comparing different forms of RT for localized prostate cancer. We performed a meta-regression of 40 individual trials with 21,429 total patients to allow a comparison of the rates and cumulative proportions of 5-year overall survival (OS), prostate cancer-specific mortality (PCSM), and distant metastasis (DM) for each treatment arm of every trial. Results Dose-escalation either in the absence or presence of STADT failed to significantly improve any 5-year outcome. In contrast, adding LTADT to low dose RT significantly improved 5-year PCSM (Odds ratio [OR] 0.34, 95% confidence interval [CI] 0.22–0.54, p < 0.001) and DM (OR 0.35, 95% CI 0.20–0.63. p < 0.001) over low dose RT alone. Adding STADT also significantly improved 5-year PCSM over low dose RT alone (OR 0.55, 95% CI 0.41–0.75, p < 0.001). Conclusion While limited by between-study heterogeneity and a lack of individual patient data, this meta-analysis suggests that adding ADT, versus increasing RT dose alone, offers a more consistent improvement in clinical endpoints.

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