scholarly journals Race/ethnicity is an Important Predictor of Life Expectancy in Localized Prostate Cancer Patients

2021 ◽  
Author(s):  
Christoph Würnschimmel ◽  
Luigi Nocera ◽  
Mike Wenzel ◽  
Claudia Collà Ruvolo ◽  
Zhe Tian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
African Americans ◽  
Life Expectancy ◽  
External Beam Radiotherapy ◽  
Life Tables ◽  
Localized Prostate Cancer ◽  
Social Security Administration ◽  
Treatment Type ◽  
Race Ethnicity

Abstract PURPOSE:To test the effect of race/ethnicity on Social Security Administration (SSA) life tables’ life-expectancy (LE) predictions in localized prostate cancer (PCa) patients treated with either radical prostatectomy (RP) or external beam radiotherapy (EBRT). We hypothesized that LE will be affected by race/ethnicity. PATIENTS AND METHODS:We relied on the 2004-2006 Surveillance, Epidemiology, and End Results database to identify D’Amico intermediate- and high-risk PCa patients treated with either RP or EBRT. SSA life tables were used to compute 10-year LE predictions and were compared to OS. Stratification was performed according to treatment type (RP/EBRT) and race/ethnicity (Caucasian, African-American, Hispanic/Latino and Asian). RESULTS:Of 55,383 assessable patients, 40,490 were Caucasian (RP 49.3% vs. EBRT 50.7%), 7,194 African-American (RP 41.3% vs. EBRT 50.7%), 4,716 Hispanic/Latino (RP 51.0% vs. EBRT 49.0%) and 2,983 were Asian (RP 41.6% vs. EBRT 58.4%). In both RP and EBRT patients, OS exceeded life tables’ LE predictions, except for African-Americans. However, in RP patients, the magnitude of the difference was greater than in EBRT. Moreover, in RP patients, OS of African-Americans virtually perfectly followed predicted LE. Conversely, in EBRT patients, the OS of African-American patients was worse than predicted LE. CONCLUSIONS:OS in RP and EBRT treated PCa patients is invariably better than respective life tables’ derived LE predictions for Caucasians, Hispanic/Latinos and Asians, but not for African-Americans. The recorded survival disadvantage in African-American RP and EBRT patients, and if applicable also in other African-American populations, warrants detailed consideration and possibly corrective measures.

Do Older Men Benefit From Curative Therapy of Localized Prostate Cancer?

2003 ◽  
Vol 21 (17) ◽  
pp. 3318-3327 ◽  
Author(s):  
Shabbir M.H. Alibhai ◽  
Gary Naglie ◽  
Robert Nam ◽  
John Trachtenberg ◽  
Murray D. Krahn
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
External Beam Radiotherapy ◽  
Case Series ◽  
Older Men ◽  
Localized Prostate Cancer ◽  
Series Data ◽  
Curative Therapy ◽  
Poorly Differentiated ◽  
Modern Radiotherapy

Purpose: Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) associated with available treatments for localized prostate cancer in men aged ≥ 65 years, adjusting for Gleason score, patient preferences, and comorbidity. Methods: We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies. Results: For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve QALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and QALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and QALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy. Conclusion: Potentially curative therapy results in significantly improved LE and QALE for older men with few comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group.

A Method for Using Life Tables to Estimate Lifetime Risk for Prostate Cancer Death

2010 ◽  
Vol 8 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Hyung L. Kim ◽  
Marvin R. Puymon ◽  
Maochun Qin ◽  
Khurshid Guru ◽  
James L. Mohler
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Gleason Score ◽  
Life Tables ◽  
Lifetime Risk ◽  
Cancer Death ◽  
Social Security Administration ◽  
Curative Therapy ◽  
Prostate Cancer Death ◽  
Estimate Lifetime Risk

Prostate cancer can have a long and indolent course, and management without curative therapy should be considered in select patients. When counseling patients, a useful way to convey the risk for death from competing causes is to estimate their lifetime risk for dying from prostate cancer. Double-decrement life tables were constructed to calculate age-specific death rates using the death probabilities from the Social Security Administration life tables and Gleason score–specific mortality rates reported from pre-PSA cohort study. The lifetime risk for prostate cancer death was calculated. Life tables provided life expectancy and risk for prostate cancer death based on age at diagnosis. For example, 60-year-old patient with a Gleason score 6, 7, or 8 tumor had an overall life expectancy of 14.4, 10.2, or 6.6 years, respectively. The risk for prostate cancer death during the expected years of life was 33%, 49%, or 57%, respectively. If a 10-year lead-time bias was assumed for PSA detection, the risks for death from prostate cancer decreased to 16%, 26%, or 37%, respectively. If the patient was in the bottom quartile for overall health and disease was detected by prostate examination, the risk for death from prostate cancer was 21%, 32%, or 40%, respectively. A Web-based tool for performing these calculations is available at http://www.roswellpark.org/Patient_Care/Specialized_Services/Prostate_Cancer_Estimator.html. Life tables can be created to estimate overall life expectancy and risk for prostate cancer death, and to assist with decision-making when considering management without curative therapy.

scholarly journals Survival advantage of Asian metastatic prostate cancer patients treated with external beam radiotherapy over other races/ethnicities

2021 ◽  
Author(s):  
Christoph Würnschimmel ◽  
Mike Wenzel ◽  
Claudia Collà Ruvolo ◽  
Luigi Nocera ◽  
Zhe Tian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Propensity Score ◽  
Cancer Patients ◽  
Metastatic Prostate Cancer ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
Multivariable Analyses ◽  
Race Ethnicity ◽  
Hispanic Latinos

Abstract Purpose To assess the effect of race/ethnicity in cancer-specific mortality (CSM) adjusted for other-cause mortality (OCM) in metastatic prostate cancer patients (mPCa) treated with external beam radiotherapy (EBRT) to the prostate. Methods We relied on the Surveillance, Epidemiology, and End Results (SEER) database to identify Caucasian, African-American, Hispanic/Latino and Asian mPCa patients treated by EBRT between 2004 and 2016. Cumulative incidence plots displayed CSM after adjustment for OCM according to race/ethnicity. Propensity score matching accounted for patient age, prostate-specific antigen, clinical T and N stages, Gleason Grade Groups and M1 substages. OCM adjusted multivariable analyses tested for differences in CSM in African-Americans, Hispanic/Latinos and Asians relative to Cauacasians. Results After 3:1 propensity score matching and OCM adjustment, Asians exhibited lower CSM at 60 and 120 months (48.2 and 60.0%, respectively) compared to Caucasians (66.7 and 79.4%, respectively, p < 0.001). In OCM adjusted multivariable analyses, Asian race/ethnicity was associated with lower CSM (HR 0.66, CI 0.52–0.83, p < 0.001). Conversely, African-American and Hispanic/Latino race/ethnicity did not affect CSM. OCM rates were comparable between examined races/ethnicities. Conclusion In the setting of mPCa treated with EBRT, Asians exhibit lower CSM than Caucasians, African-Americans and Hispanic/Latinos. This observation may warrant consideration in prognostic stratification schemes for newly diagnosed mPCa patients.

scholarly journals Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study

2021 ◽  
Author(s):  
E. Sutton ◽  
◽  
J. A. Lane ◽  
M. Davis ◽  
E. I. Walsh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Qualitative Interviews ◽  
Well Being ◽  
Localized Prostate Cancer ◽  
Short Term ◽  
Age Related ◽  
Qualitative Interview Study ◽  
Long Term Treatment

Abstract Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.

scholarly journals Addition of Androgen-Deprivation Therapy or Brachytherapy Boost to External Beam Radiotherapy for Localized Prostate Cancer: A Network Meta-Analysis of Randomized Trials

2020 ◽  
Vol 38 (26) ◽  
pp. 3024-3031 ◽  
Author(s):  
William C. Jackson ◽  
Holly E. Hartman ◽  
Robert T. Dess ◽  
Sam R. Birer ◽  
Payal D. Soni ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Randomized Trials ◽  
Practice Patterns ◽  
Meta Analysis ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
External Beam ◽  
Brachytherapy Boost ◽  
Meta Analyses

PURPOSE In men with localized prostate cancer, the addition of androgen-deprivation therapy (ADT) or a brachytherapy boost (BT) to external beam radiotherapy (EBRT) have been shown to improve various oncologic end points. Practice patterns indicate that those who receive BT are significantly less likely to receive ADT, and thus we sought to perform a network meta-analysis to compare the predicted outcomes of a randomized trial of EBRT plus ADT versus EBRT plus BT. MATERIALS AND METHODS A systematic review identified published randomized trials comparing EBRT with or without ADT, or EBRT (with or without ADT) with or without BT, that reported on overall survival (OS). Standard fixed-effects meta-analyses were performed for each comparison, and a meta-regression was conducted to adjust for use and duration of ADT. Network meta-analyses were performed to compare EBRT plus ADT versus EBRT plus BT. Bayesian analyses were also performed, and a rank was assigned to each treatment after Markov Chain Monte Carlo analyses to create a surface under the cumulative ranking curve. RESULTS Six trials compared EBRT with or without ADT (n = 4,663), and 3 compared EBRT with or without BT (n = 718). The addition of ADT to EBRT improved OS (hazard ratio [HR], 0.71 [95% CI, 0.62 to 0.81]), whereas the addition of BT did not significantly improve OS (HR, 1.03 [95% CI, 0.78 to 1.36]). In a network meta-analysis, EBRT plus ADT had improved OS compared with EBRT plus BT (HR, 0.68 [95% CI, 0.52 to 0.89]). Bayesian modeling demonstrated an 88% probability that EBRT plus ADT resulted in superior OS compared with EBRT plus BT. CONCLUSION Our findings suggest that current practice patterns of omitting ADT with EBRT plus BT may result in inferior OS compared with EBRT plus ADT in men with intermediate- and high-risk prostate cancer. ADT for these men should remain a critical component of treatment regardless of radiotherapy delivery method until randomized evidence demonstrates otherwise.

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