High-risk prostate cancer in the United States, 1990–2007

Abstract

Objectives-This study aimed to describe national trends in presentation, management, and outcomes for men with high risk prostate cancer. There has been no consistent risk migration within the high risk group over time. Treatment varies substantially with CAPRA score within the high risk group, with higher risk men less likely to receive local therapy. Use of androgen deprivation therapy has increased over time, both as primary therapy and in conjunction with both external beam radiation and brachytherapy. Biochemical outcomes vary according to CAPRA score within the high risk group. Methods-DataConclusions-Clinical stage T2c should not define high risk, and the high risk group should be substratified using a multivariable instrument. There is no evidence for meaningful downward risk migration among high-risk patients over the past 15 years. At least some men in the high risk group may be under-treated.

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

“…Our data, by contrast, suggest that clinical stage T2c alone should not be sufficient for classification in this high risk category. 30 Our study is not without limitations. Our data set is derived from a diverse group of primarily community based urological practices.…”

Association of Insurance and Race/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006

“…Earlier studies on disease severity have relied on clinical series, abstraction of data for relatively small samples of patients from central registries, and the Cancer of the Prostate Strategic Urologic Research Endeavor database, which includes over 13,000 patients with prostate cancer enrolled from 40 urology practices throughout the United States (7)(8)(9). These studies suggest that clinical severity at diagnosis varies by race and ethnicity (6,10,11).…”

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

“…The lack of election and adherence to active surveillance in the U.S. is indicative of the observed patterns in overtreatment of low-risk disease, but undertreatment of high-risk disease has also been identified [7,19,52]. The 10-year cancer specific survival rate for prostate cancer patients treated by initial observational management for poorly differentiated disease (Gleason score 8-10) was reported to be 58-74%, suggesting that this group would have benefited appreciably from more aggressive treatment modalities [42].…”