Endocrine therapy in prostate cancer: time for reappraisal of risks, benefits and cost-effectiveness?

Bourke, Liam; Kirkbride, Peter; Hooper, Richard; Rosario, A J; Chico, Timothy J. A.; Rosario, Derek J.

doi:10.1038/bjc.2012.523

Cited by 53 publications

(41 citation statements)

References 34 publications

(44 reference statements)

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“…The benefits of androgen deprivation therapy are well recognized, and a multitude of studies have documented the benefits of androgen deprivation therapy in conjunction with other therapies. 16 In our study, we observed that the overall survival rate of the older patients was higher than that of the younger patients, and the decreased androgen level in the older patients may at least partially explain this difference. In addition, osteogenic bone destruction is a characteristic of PCa with bone metastasis.…”

Section: Discussionmentioning

confidence: 53%

Clinical features and treatment strategies for older prostate cancer patients with bone metastasis

Yang¹,

Qi²,

Rong³

et al. 2013

Asian J Androl

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To identify the clinical features and independent predictors of survival in older patients with bone metastasis from prostate cancer (PCa). We retrospectively analysed 205 older patients with bone metastases from PCa between 1997 and 2012. The Kaplan-Meier method was used with the log-rank test for survival rate calculations and to evaluate each variable. Multivariate analysis was performed with the Cox regression model. The chi-squared test was used to compare survival rates between older and younger (n5197) patients. All patients were followed up. The 1-, 2-, 3-and 5-year survival rates were 95.5%, 77.5%, 68.5% and 33.7%, respectively. Gleason score, radiotherapy of the primary tumour, the number of bone metastases, the alkaline phosphatase alkaline phosphatase (ALP) level, organ metastasis and regional lymph node metastasis were associated with the survival rates. Multivariate Cox regression analysis showed that Gleason score at diagnosis of the primary tumour was a significant predictor of overall survival following the diagnosis of bone metastases. In addition, the overall survival rates of older patients were higher compared with younger patients, but older patients who underwent radiotherapy had higher mortality. These data may serve as a guide for creating clinical prediction models in further studies. INTRODUCTIONProstate cancer (PCa) is the most commonly diagnosed malignancy among males in developed countries and the second leading cause of cancer-related mortality. 1 Currently, the incidence is rapidly increasing in developing Asian counties such as China. It is the only solid tumour diagnosed with its first recurrence as bone metastases instead of visceral metastases. PCa frequently metastasizes to bone, and treatment with androgen deprivation leads to accelerated bone loss, resulting in clinically relevant skeletal complications associated with disabling symptoms. 2 Among patients who die from PCa, the incidence of skeletal involvement appears to be .85%. 3,4 Eisenberger and Hussain et al. 5 identified baseline covariates that predict the long-term survival of patients with metastatic PCa based on the Southwest Oncology Group criteria. Minimal disease, better Southwest Oncology Group performance status, no bone pain, lower Gleason score and lower prostate-specific antigen (PSA) level were independent factors associated with longer survival. 5 In our previous study, we found that bone metastasis of PCa was more common in older males, 6 but no prognostic factors for these PCa patients were identified. In this retrospective study, the sample size was enlarged and 205 PCa patients older than 70 with bone metastases were included. The patients' clinical features and main prognostic factors, including age, Gleason score, stage, endocrine therapy, castration, radiotherapy, number of bone lesions, PSA and alkaline phosphatase (ALP) levels, neighbouring organ metastasis, regional and remote lymph node metastases, invasion of the surrounding parenchyma and other

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Section: Discussionmentioning

confidence: 53%

Clinical features and treatment strategies for older prostate cancer patients with bone metastasis

Yang¹,

Qi²,

Rong³

et al. 2013

Asian J Androl

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“…[40] The association between ADT and cardiovascular risk remains controversial and this has been discussed elsewhere. [33,36,41] …”

Section: Androgen Deprivation Therapymentioning

confidence: 99%

“…These have been extensively covered in a recent review in European Urology. [30] Briefly, these include increased fracture risk, [31] metabolic consequences and cardiovascular events, [32][33][34][35][36] genital and sexual dysfunction, [37,38] fatigue [39] and anaemia. [40] The association between ADT and cardiovascular risk remains controversial and this has been discussed elsewhere.…”

Section: Androgen Deprivation Therapymentioning

confidence: 99%

Survivorship and Improving Quality of Life in Men with Prostate Cancer

et al. 2015

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“…16 Once again, methodological flaws mean that the data are not conclusive; there were participants in the control group receiving ADT, and in the intervention group the median duration of ADT was only six months. 17 There are many potential reasons why these RCTs may have shown different results from observational studies, including the RCTs enrolling younger patients with less comorbidity and lower risk of CV events, while excluding patients with comorbidities and potentially less healthy lifestyles. Furthermore, non-fatal CV events are frequently under-reported in oncological RCTs, despite their significant impact on quality of life.…”

Section: Wwwtrendsinmenshealthcom Trends In Urology and Men's Health mentioning

confidence: 99%

Managing cardiovascular risk in high‐risk prostate cancer

Plummer¹,

Collins²,

Rosario³

et al. 2017

Trends Urol & Men's Health

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Men living with prostate cancer have a high rate of cardiovascular events, and many of them have risk factors that would be an indication for primary prevention under current guidance. These risks may be increased by certain androgen deprivation therapies. This article reports the outcome of a consensus meeting at which the authors discussed these issues. They suggest a simple assessment tool for use with prostate cancer patients to rapidly assess cardiovascular risk and allow appropriate risk‐management strategies to be implemented.

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Endocrine therapy in prostate cancer: time for reappraisal of risks, benefits and cost-effectiveness?

Cited by 53 publications

References 34 publications

Clinical features and treatment strategies for older prostate cancer patients with bone metastasis

Clinical features and treatment strategies for older prostate cancer patients with bone metastasis

Survivorship and Improving Quality of Life in Men with Prostate Cancer

Managing cardiovascular risk in high‐risk prostate cancer

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