Initiation of Systemic Therapy During the Last 30 Days of Life in Patients With Metastatic Castration-resistant Prostate Cancer

Nieder, Carsten; Haukland, Ellinor; Mannsåker, Bård; Pawinski, Adam; Yobuta, Rosalba; Norum, Jan

doi:10.21873/anticanres.13116

Cited by 4 publications

(3 citation statements)

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“…Serum PSA is influenced by benign conditions such as prostatic inflammation . Some commonly used medications, including statins, influence PSA level . Statins inhibit endogenous cholesterol production and block protein prenylation, potentially influencing PCa cell proliferation and migration .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

et al. 2022

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IMPORTANCE Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. OBJECTIVETo investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. DESIGN, SETTING, AND PARTICIPANTS This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. INTERVENTIONS Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care.MAIN OUTCOMES AND MEASURES Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. RESULTSThe study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. CONCLUSION AND RELEVANCEIn this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

et al. 2022

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“…The setting of care was the publicly funded Norwegian healthcare system, which aims at equal access to treatment without financial barriers, e.g., by providing travel and accommodation [13,14]. Norway has been known for a policy that minimises poverty and offers public health insurance to all inhabitants.…”

Section: Introductionmentioning

confidence: 99%

Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway?

Nieder

Dalhaug

Haukland

2020

International Journal of Circumpolar Health

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The winter darkness or polar night induces endocrine and metabolic mechanisms, which might reduce the efficacy of cancer treatment and thus contribute to shorter survival. Moreover, seasonand weather-related treatment delays and irregularities might also cause reduced efficacy of anticancer drugs. Therefore, this study evaluated the prognostic impact of timing of chemotherapy (start during winter darkness or outside of this season), in terms of overall survival, in patients with metastatic castration-resistant prostate cancer (MCRPC) who received oncology care at the Nordland hospital Bodø. The study included 111 patients treated with first-line docetaxel chemotherapy for MCRPC. Twenty patients (18%) started their treatment during winter darkness (arbitrarily defined as ±4 weeks around 21 December). In unadjusted univariate analysis, survival was shorter in this group (median 10.2 vs. 18.9 months, p = 0.055). However, not all baseline parameters were equally distributed between the two groups. In multivariable-adjusted Cox regression analysis accounting for several confounding variables, only one factor was statistically significant: pre-chemotherapy serum lactate dehydrogenase level (a surrogate marker of disease burden). Thus, the present results suggest that seasonal variation is not a major contributor to the diverging survival outcomes observed after docetaxel chemotherapy.

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“…The survival prognosis of these patients is heterogeneous, too. Pain might be present already as the first sign of cancer in patients expected to survive for several years, or in the pre-terminal and terminal phase when all systemic therapies have been stopped due to futility and/or the patients' reduced general condition (4)(5)(6)(7)(8). This heterogeneity causes uncertainty regarding treatment decisions, such as the decision to irradiate at all and the choice of fractionation regimen (9)(10)(11).…”

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confidence: 99%

Independent Validation of a Comprehensive Machine Learning Approach Predicting Survival After Radiotherapy for Bone Metastases

2021

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Background/Aim: The aim of this study was to analyze the survival predictions obtained from a web platform allowing for computation of the so-called Bone Metastases Ensemble Trees for Survival (BMETS). This prediction model is based on a machine learning approach and considers 27 prognostic covariates. Patients and Methods: This was a retrospective single-institution analysis of 326 patients, managed with palliative radiotherapy for bone metastases. Deviations between model-predicted survival and observed survival were assessed. Results: The median actuarial survival was 7.5 months. In total, 59% of patients survived for a period shorter than predicted. Twenty percent of the predictions of the median survival deviated from the observed survival by at least 6 months. Regarding actual survival <3 months (99 of 326 patients), the BMETS-predicted median survival was <3 months, i.e. correct in 67 of 99 cases (68%), whereas the model predicted a median of 4-6 months in 16 (16%) and of >6 months in another 16 cases. Conclusion: The model predicted survival with high accuracy in a large number of patients. Nevertheless, if the model predicts a low likelihood of 3-month survival, actual survival may be very poor (often 1 month or less). Also, in patients who died within 3 months from the start of radiotherapy, the model often predicted longer survival (16% had >6 months predicted median survival). It would, therefore, be interesting to feed the U.S. database utilized to develop the BMETS with additional poor-prognosis patients to optimize the predictions.

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Initiation of Systemic Therapy During the Last 30 Days of Life in Patients With Metastatic Castration-resistant Prostate Cancer

Cited by 4 publications

References 15 publications

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway?

Independent Validation of a Comprehensive Machine Learning Approach Predicting Survival After Radiotherapy for Bone Metastases

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