scholarly journals Recommendations by Canadian urologists and radiation oncologists for the treatment of clinically localized prostate cancer

2013 ◽  
Vol 2 (3) ◽  
pp. 197 ◽  
Author(s):  
Andrew Pearce ◽  
Chris Newcomb ◽  
Siraj Husain
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Psa Screening ◽  
Radiation Oncologists ◽  
Risk Prostate Cancer

Objective: Previous work has shown that urologists and radiation oncologists prefer the treatment that they themselves deliver when treating clinically localized prostate cancer. Our objective was to determine whether Canadian radiation oncologists and urologists have similar biases in favour of the treatments that they themselves deliver for localized prostate cancer.Methods: We developed a survey to poll the beliefs that Canadian radiation oncologists and urologists held toward prostate specific antigen (PSA) screening, survival benefits of treatment, recommendations for treatment of prostate cancer and the likelihood of side effects with each therapy.Results: Urologists were more likely to recommend routine PSA screening for men up to age 70 (p < 0.001), while radiation oncologists were more likely to recommend PSA screening for men over age 80 (p < 0.04). More urologists felt that there was “definitely” a survival advantage with radical prostatectomy (RP) (60% v. 21%, p < 0.001). More radiation oncologists recommend external beam radiation therapy (EBRT) (p < 0.01) or brachytherapy (p < 0.03) to treat low-risk prostate cancer. More urologists than radiation oncologists recommend RP for intermediate-risk patients (98% v. 70%, p < 0.001).Conclusion: Most Canadian urologists and radiation oncologists recommend routine PSA screening for men aged 50 to 70. A significant preference was detected among both urologists and radiation oncologists for the treatment that they themselves deliver. While both urologists and radiation oncologists recommend prostatectomy for the treatment of low-risk localized prostate cancer, urologist sare significantly less likely to recommend EBRT. Conversely, when patients present with intermediate-risk prostate cancer, radiation oncologists were significantly less likely than urologists to recommend a prostatectomy.

Determinants of the combined use of external beam radiation therapy and brachytherapy for low-risk localized prostate cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16039-e16039
Author(s):  
Ruben G. W. Quek ◽  
Viraj A. Master ◽  
Kevin C. Ward ◽  
Chun Chieh Lin ◽  
Katherine S. Virgo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Combined Therapy ◽  
Medical Schools ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Radiation Oncologists ◽  
Combined Use ◽  
Region Of Residence

e16039 Background: Prostate cancer treatment patterns have been shown to vary by physician and patient characteristics. For low-risk localized prostate cancer patients, we examined the association between their region of residence and their radiation oncologists’ practice affiliations with medical schools on the likelihood they would receive both external beam radiation therapy (EBRT) and brachytherapy (BT) – a treatment regimen that is at variance with clinical guidelines and has not been shown to improve survival or other patient centered outcomes. Methods: Using the Surveillance, Epidemiology and End Results – Medicare linked database and the American Medical Association Physician Masterfile, we conducted a retrospective cohort study of 4,479 patients aged 66 years or older who were diagnosed between 2004-2007 with low-risk localized prostate cancer, and the 401 radiation oncologists who saw them. Multilevel regression analyses were used to evaluate the influence of patients’ region of residence and radiation oncologists’ practice affiliations with medical schools on the combined use of EBRT and BT on patients within 6 months of diagnosis. Results: Overall, 231 (5.2%) patients received combined EBRT and BT. After adjusting for patient, tumor and radiation oncologist characteristics, patients who saw radiation oncologists with no practice affiliation with medical schools were significantly more likely to receive combined EBRT and BT (odds ratio [OR], 3.14; 95% confidence interval [95% CI], 1.50-6.59, p = 0.003). Regional variations were also observed; the odds of receiving combined therapy for patients residing in California (OR, 0.1; 95% CI, 0.03-0.33, p<0.0001) were significantly less than those in Georgia (OR, 1.0; referent). Conclusions: Low-risk localized prostate cancer patients residing in Georgia were significantly more likely to receive combined EBRT and BT when compared to those in other SEER Regions. Radiation oncologists without practice affiliations with medical schools were significantly more likely to treat patients with combined therapy; such treatment patterns are not consistent with clinical guidelines and unlikely to have significant survival benefit.

Predictors of prostate cancer-specific mortality in elderly men with intermediate-risk prostate cancer treated with radiation therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9543-9543
Author(s):  
A. Nanda ◽  
M. Chen ◽  
B. J. Moran ◽  
M. H. Braccioforte ◽  
D. Dosoretz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Elderly Men ◽  
Beam Radiation ◽  
Increased Risk ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality

9543 Background: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for co-morbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy (EBRT). Methods: The study cohort comprised 1,978 men of median age 71 (interquartile range [IQR], 66–75) years with intermediate-risk prostate cancer (Gleason score 7 with PSA 20 ng/mL or less and tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether presence of cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category were associated with the risk of PCSM. Results: After a median follow up of 3.2 (IQR, 1.7 - 5.4) years, 15 men were observed to experience PCSM. The presence of CVD was significantly associated with a decreased risk of PCSM (AHR 0.20, 95% CI 0.04 - 0.99, P = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (AHR 1.14, 95% CI 1.02 - 1.27, P = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (P = 0.03) in men with PSA levels above as compared to the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (P = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: Detection of intermediate-risk prostate cancer in elderly men without CVD at lower PSA levels is associated with a lower risk of PCSM; this risk reduction is not observed in men with known CVD. [Table: see text] No significant financial relationships to disclose.

Gleason score upgrade among 10,282 men who underwent surgery as initial treatment in 2010: A population-based study.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 72-72
Author(s):  
Hong Zhang ◽  
Edward M. Messing ◽  
Hamza Ahmed ◽  
Yuhchyau Chen
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Specific Antigen ◽  
Low Risk ◽  
Categorical Variables ◽  
Intermediate Risk ◽  
Time Of Surgery ◽  
Significant Difference ◽  
Risk Prostate Cancer

72 Background: Active surveillance is now accepted initial management for men who have localized prostate cancer with low risk of disease progression. Many criteria have been used for patient identification, including Gleason score (GS) obtained from prostate biopsy. Because of concerns of sampling error, some have recommended repeated biopsy before committing to active surveillance. However, there is limited information about the risk of missing high grade disease using the current standard biopsy approach. This study seeks to compare GS difference from biopsy and surgery to provide an estimated rate of GS upgrade. Methods: The Surveillance, Epidemiology, and End Results (SEER) program was used to identify men with American Joint Committee on Cancer stage T1-2cN0M0 prostate cancer diagnosed between January 2010 and December 2010. Patients who underwent prostatectomy were selected for further analysis. Based on prostate-specific antigen (PSA) levels and GS, cases were divided into low (PSA <=10 and GS <=6) and intermediate (10<PSA<=20 or GS=7) risk groups. The rates of GS upgrade were reported for each group. Chi-square tests were used to assess differences in categorical variables (e.g. age and race) between groups of GS upgrade and no change/downgrade. Results: A total of 10,282 men were evaluated, with 9.2% (n=942) having low-risk disease, and 90.8% (n=9340) having intermediate-risk disease. Among men with low-risk prostate cancer, 22.3% (n=210) had GS upgrade and 0.8% (n=8) had GS 8 disease. Among men with intermediate risk disease, 26.2% (n=2446) had GS upgrade and 2.3% (n=214) had GS 8 disease. There was no statistically significant difference in either age or race distribution among men who had GS upgrade versus no change or downgrade at the time of surgery. Conclusions: A substantial number of low- and intermediate-risk prostate cancer patients had GS upgrade at the time of surgery, but few had upgraded to GS 8 high risk disease. These observations suggest that repeat biopsy prior to active surveillance may not be necessary.

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