scholarly journals An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

2016 ◽  
Vol 10 (11-12) ◽  
pp. 410
Author(s):  
Majed Alghamdi ◽  
Amandeep Taggar ◽  
Derek Tilley ◽  
Marc Kerba ◽  
Xanthoula Kostaras ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Medical Records ◽  
Specific Antigen ◽  
Referral Rates ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Pre Treatment ◽  
The Impact ◽  
Alberta Cancer Registry

Introduction: We aimed to determine the impact of clinical practice guidelines (CPG) on rates of radiation oncologist (RO) referral, androgen-deprivation therapy (ADT), radiation therapy (RT), and radical prostatectomy (RP) in patients with high-risk prostate cancer (HR-PCa).Methods: All men >18 years, diagnosed with PCa in 2005 and 2012 were identified from the Alberta Cancer Registry. Patient age, aggregated clinical risk group (ACRG) score, Gleason score (GS), pre-treatment prostate-specific antigen (PSA), RO referral, and treatment received were extracted from electronic medical records. Logistic regression modelling was used to examine associations between RO referral rates and relevant factors.Results: HR-PCa was diagnosed in 261 of 1792 patients in 2005 and 435 of 2148 in 2012. Median age and ACRG scores were similar in both years (p>0.05). The rate of patients with PSA >20 were 67% and 57% in 2005 and 2012, respectively (p=0.004). GS ≤6 was found in 13% vs. 5% of patients, GS 7 in 27% vs. 24%, and GS ≥8 in 59% vs. 71% in 2005 and 2012, respectively (p<0.001). In 2005, RO referral rate was 68% compared to 56% in 2012 (p=0.001), use of RT + ADT was 53% compared to 32% (p<0.001), and RP rate was 9% vs. 17% (p=0.002). On regression analysis, older age, 2012 year of diagnosis and higher PSA were associated with decreased RO referral rates (odds ratios [OR] 0.49, 95% confidence interval [CI] 0.39–0.61; OR 0.51, 95% CI 0.34–0.76; and OR 0.64, 95% CI 0.39–0.61), respectively [p<0.001]).Conclusions: Since CPG creation in 2005, RO referral rates and ADT + RT use declined and RP rates increased, which demonstrates a need to improve adherence to CPG in the HR-PCa population.

scholarly journals The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer

Cancer ◽  
2014 ◽  
Vol 120 (11) ◽  
pp. 1656-1662 ◽  
Author(s):  
Michael R. Abern ◽  
Martha K. Terris ◽  
William J. Aronson ◽  
Christopher J. Kane ◽  
Christopher L. Amling ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Oncologic Outcomes ◽  
High Risk Prostate Cancer ◽  
Pathologic Staging ◽  
Risk Prostate Cancer ◽  
The Impact

scholarly journals Circulating mRNA signature as a marker for high-risk prostate cancer

2019 ◽  
Vol 41 (2) ◽  
pp. 139-145
Author(s):  
Marilesia Ferreira De Souza ◽  
Hellen Kuasne ◽  
Mateus De Camargo Barros-Filho ◽  
Heloísa Lizotti Cilião ◽  
Fabio Albuquerque Marchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
Treatment Decision ◽  
Tumor Stage ◽  
Aggressive Disease ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Invasive Method ◽  
Biopsy Gleason Score

Abstract Prostate cancer (PCa) is the second most common cancer in men. The indolent course of the disease makes the treatment choice a challenge for physicians and patients. In this study, a minimally invasive method was used to evaluate the potential of molecular markers in identifying patients with aggressive disease. Cell-free plasma samples from 60 PCa patients collected before radical prostatectomy were used to evaluate the levels of expression of eight genes (AMACR, BCL2, NKX3-1, GOLM1, OR51E2, PCA3, SIM2 and TRPM8) by quantitative real-time PCR. Overexpression of AMACR, GOLM1, TRPM8 and NKX3-1 genes was significantly associated with aggressive disease characteristics, including extracapsular extension, tumor stage and vesicular seminal invasion. A trio of genes (GOLM1, NKX3-1 and TRPM8) was able to identify high-risk PCa cases (85% of sensitivity and 58% of specificity), yielding a better overall performance compared with the biopsy Gleason score and prostate-specific antigen, routinely used in the clinical practice. Although more studies are required, these circulating markers have the potential to be used as an additional test to improve the diagnosis and treatment decision of high-risk PCa patients.

scholarly journals Phase III Intergroup Trial of Adjuvant Androgen Deprivation With or Without Mitoxantrone Plus Prednisone in Patients With High-Risk Prostate Cancer After Radical Prostatectomy: SWOG S9921

2018 ◽  
Vol 36 (15) ◽  
pp. 1498-1504 ◽  
Author(s):  
Maha Hussain ◽  
Catherine M. Tangen ◽  
Ian M. Thompson ◽  
Gregory P. Swanson ◽  
David P. Wood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Hazard Ratio ◽  
Phase Iii ◽  
Adjuvant Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Purpose Patients with high-risk prostate cancer after radical prostatectomy are at risk for death. Adjuvant androgen-deprivation therapy (ADT) may reduce this risk. We hypothesized that the addition of mitoxantrone and prednisone (MP) to adjuvant ADT could reduce mortality compared with adjuvant ADT alone. Methods Eligible patients had cT1-3N0 prostate cancer with one or more high-risk factors after radical prostatectomy (Gleason score [GS] ≥ 8; pT3b, pT4, or pN+ disease; GS 7 and positive margins; or preoperative prostate-specific antigen [PSA] > 15 ng/mL, biopsy GS score > 7, or PSA > 10 ng/mL plus biopsy GS > 6. Patients with PSA ≤ 0.2 ng/mL after radical prostatectomy were stratified by pT/N stage, GS, and adjuvant radiation plan and randomly assigned to ADT (bicalutamide and goserelin for 2 years) or ADT plus six cycles of MP. The primary end point was overall survival (OS). Median OS was projected to be 10 years in the ADT arm, requiring 680 patients per arm to detect a hazard ratio of 1.30 with 92% power and one-sided α = .05. Results Nine hundred sixty-one eligible intent-to-treat patients were randomly assigned to ADT or ADT + MP from October 1999 to January 2007, when the Data Safety Monitoring Committee recommended stopping accrual as a result of higher leukemia incidence with ADT + MP. Median follow-up was 11.2 years. The 10-year OS estimates were 87% with ADT (expected 50%) and 86% with ADT + MP (hazard ratio, 1.06; 95% CI, 0.79 to 1.43). The 10-year estimate for disease-free survival was 72% for both arms. Prostate cancer was the cause of death in 18% of patients in the ADT arm and 22% in the ADT + MP arm. More patients in the MP arm died of other cancers (36% v 18% in ADT alone arm). Conclusion MP did not improve OS and increased deaths from other malignancies. The DFS and 10-year OS in these patients treated with 2 years of ADT were encouraging compared with historical estimates, although a definitive conclusion regarding value of ADT may not be made without a nontreatment control arm.

The effects of anticoagulant use in high-risk prostate cancer treated with radiotherapy on overall survival and biochemical control.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 146-146
Author(s):  
Stephen G. Chun ◽  
Corbin D Jacobs ◽  
Jingsheng Yan ◽  
Xian-Jin Xie ◽  
Kevin S Choe ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Treatment Outcomes ◽  
Distant Metastasis ◽  
Medical Center ◽  
Specific Antigen ◽  
Therapeutic Resistance ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

146 Background: High-risk localized prostate cancer (PC) has suboptimal treatment outcomes due to therapeutic resistance to radiation and hormone therapy. Previous studies suggest that anticoagulant (AC) use may improve treatment outcomes in high-risk PC. We hypothesized that AC therapy confers a freedom from biochemical failure (FFBF) and overall survival (OS) benefit in patients treated with concurrent radiotherapy in patients with high-risk prostate cancer defined as Gleason Score (GS) 8 or higher, Stage T3a or higher, or prostate-specific antigen (PSA) of 20 or more. Methods: Analysis was performed of 74 patients identified who were treated with definitive external beam radiotherapy with National Comprehensive Cancer Network defined high-risk PC from 2005 to 2008 at The University of Texas Southwestern Medical Center. Of these patients, 43 took concurrent AC including aspirin (95.6%), clopidogrel (17.8%), warfarin (20%), and multiple ACs (31.1%). Associations between AC use and FFBF, OS, distant metastasis, and toxicity were explored. A minimum of 5 years of follow-up were available for all patients. Results: For patients taking any AC compared to no AC, there was improved FFBF compared to of 84.4% versus 62.1% (P = 0.0003), and for aspirin the FFBF was 83.7% versus 64% (P = 0.0008). Aspirin was also associated with reduced rates of distant metastasis of 12.2% versus 26.7% in patients who did not take aspirin (P = 0.039). On multivariate analysis, patients taking aspirin with PSA of 20 or more had 5 year OS 95.8% versus 70% (P = 0.031), and GS 9-10 had 5 year OS 88.2% versus 37.5% (P = 0.013). Conclusions: AC use was associated with a FFBF benefit in high-risk PC which translated into an OS benefit in the highest risk PC patients with PSA of 20 or more or GS 9 to 10 who are most likely to experience prostate cancer specific mortality. This hypothesis generating data suggests AC use may represent an opportunity to improve patient outcomes by overcoming therapeutic resistance.

Survival impact of initial local therapy selection for men under 60 with high risk prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5082-5082
Author(s):  
Adeel Kaiser ◽  
Soren Bentzen ◽  
Minhaj Siddiqui ◽  
Michael J Naslund ◽  
Young Kwok ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Hormonal Therapy ◽  
Local Therapy ◽  
External Beam Radiation ◽  
Comorbidity Score ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
The Impact

5082 Background: The impact of initial local therapy selection on survival for high risk prostate cancer (PCa) patients remains uncertain. We sought to assess this effect, while limiting competing causes of death, through the examination of a younger PCa patient cohort within the National Cancer Database. Methods: We evaluated the overall survival (OS) of men under 60 with high risk PCa receiving either radiation therapy (RT) or radical prostatectomy (RP). All men in this age group were treated between 2004 and 2013, harbored cN0M0 disease, and presented with Gleason Scores (GS) of 8 to 10. The RT group included patients who received external beam radiation (EBRT) alone or EBRT in combination with brachytherapy (BT). Overall survival and covariates were evaluated using multivariable Cox regression analysis. Results: A total of 16,944 patients met inclusion criteria of which 12,155 underwent RP and 4,789 received RT as initial therapy. 82.5% of RT patients received hormonal therapy, and the median dose was 77.4 Gy. In the RP group, 17.2% of patients received postoperative radiation, and 87% of these cases received a dose exceeding 64.80 Gy. The RP group had a higher proportion of cases with Charlson-Deyo comorbidity score > 0 (15.2% v. 11.2%, p < 0.000001). At a median follow-up of 50 months (0 - 131 months), RP was associated with improved OS in comparison to RT (hazard ratio = 0.52; 95% CI (0.47, 0.58); p < 0.000001). The estimated 8-year OS (±1 standard error of the estimate) was 85.1±0.7% and 74.9±0.7%, after RP and RT, respectively. This benefit remained present when adjusting for age, year of treatment, race, comorbidity score, Gleason score, T stage, hormonal therapy, chemotherapy, form of radiation, PSA, or insurance status. Conclusions: Compared to RT, initial treatment of men under 60 with high risk PCa with RP results in a large, statistically significant improvement in overall survival that remains consistent over time and remains significant in a multivariable model adjusting for known prognostic variables. These results are limited by the retrospective nature of the database analysis, and the lack of cancer specific survival information.

The Impact of Brachytherapy Boost on Overall Survival in Men with High Risk Prostate Cancer and a Very High PSA: Is There a PSA Ceiling?

Brachytherapy ◽  
2018 ◽  
Vol 17 (4) ◽  
pp. S18
Author(s):  
Amishi Bajaj ◽  
Brendan Martin ◽  
Alexander Harris ◽  
Derrick Lock ◽  
Matthew M. Harkenrider ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost ◽  
The Impact ◽  
Very High
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