Long-Term Hazard of Progression After Radical Prostatectomy for Clinically Localized Prostate Cancer: Continued Risk of Biochemical Failure After 5 Years

Amling, Christopher L.; Blute, Michael L.; Bergstralh, Erik J.; Seay, Thomas M.; Slezak, Jeffrey M.; Zincke, Horst

doi:10.1097/00005392-200007000-00023

Cited by 79 publications

(99 citation statements)

References 22 publications

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“…Therefore, we were required to create ad hoc definitions for cancer-specific and other-cause mortality for the men who were lost to follow-up. However, in addition to making our definitions very conservative based on existing data, 9,[19][20][21] historic evidence supports the extremely low rates of prostate cancer mortality among men with low-risk disease. [8][9][10]14 In conclusion, we have demonstrated that the men with the most severe comorbidity in our cohort (ie, those with Charlson scores !3) were overtreated with aggressive treatment for low-risk prostate cancer in 54% of cases.…”

Section: Original Article 2064mentioning

confidence: 88%

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Daskivich

Chamie

Kwan

et al. 2010

Cancer

127

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BACKGROUND: Men with low-risk prostate cancer and significant comorbidity are susceptible to overtreatment. The authors sought to compare the impact of comorbidity and age on treatment choice in men with low-risk disease. METHODS: The authors sampled 509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1997 and 2004. Rates of aggressive treatment (radical prostatectomy, radiation therapy, brachytherapy) were determined among men of different ages and with different Charlson comorbidity scores. Multivariate modeling was used to determine the influence of both variables in predicting nonaggressive treatment, and Cox proportional hazards analysis was used to compare the risk of other-cause mortality among groups according to Charlson score and age. RESULTS: Men with Charlson scores !3 were treated aggressively in 54% of cases (30 of 56 men), while men aged >75 years at diagnosis were treated aggressively in 16% of cases (7 of 44 men). In multivariate analysis, age >75 years was a much stronger predictor of nonaggressive treatment (relative risk, 12.0; 95% confidence interval [CI], 5.4-28.3) than a Charlson score !3 (relative risk, 2.0; 95% CI, 1.3-2.9). In survival analysis, men with Charlson scores !3 had an 8-fold increased risk (hazard ratio, 8.4; 95% CI, 4.2-16.6) and 70% probability of other-cause mortality at 10 years, whereas age >75 years was associated with a 5-fold increased risk (hazard ratio, 4.9; 95%CI, 1.7-13.8) and a 24% probability of other-cause mortality. CONCLUSIONS: Men with significant comorbidity often were overtreated for low-risk prostate cancer. Like advanced age, significant comorbidity should be a strong relative contraindication to aggressive treatment in men with low-risk disease. Cancer 2011;117:2058-66.

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Section: Original Article 2064mentioning

confidence: 88%

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Daskivich

Chamie

Kwan

et al. 2010

Cancer

127

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“…1 However, a significant proportion of patients can experience disease recurrence and prostate specific antigen (PSA) progression is the earliest evidence of persistent or recurrent disease after primary therapy with curative intent. 2 In previously untreated patients with nonmetastatic PCa 150 mg bicalutamide monotherapy has been shown to be equivalent to castration in terms of the survival rate at a median followup of 6.3 years, offering quality of life (QOL) advantages with respect to sexual interest and physical capacity.…”

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confidence: 99%

Gynecomastia and Breast Pain Induced by Adjuvant Therapy With Bicalutamide After Radical Prostatectomy in Patients With Prostate Cancer: The Role of Tamoxifen and Radiotherapy

Lorenzo¹,

Perdonà²,

Placido³

et al. 2005

Journal of Urology

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Purpose: We investigated the role of tamoxifen and radiotherapy (RT) for the prevention and treatment of gynecomastia and breast pain during adjuvant bicalutamide monotherapy after radical prostatectomy (RP) in patients with prostate cancer. Also, we evaluated their effects on patient hormonal status, quality of life (QOL), sexual function and prostate specific antigen relapse-free survival.Materials and Methods: This was a multicenter prospective trial. From January 2002 to February 2004, 102 patients who had undergone RP for localized or locally advanced prostate cancer were recruited and randomized into 3 groups, namely group 1-those receiving only 150 mg bicalutamide as adjuvant hormonal therapy, group 2-those receiving bicalutamide and 10 mg tamoxifen, and group 3-those receiving bicalutamide and RT. Patients in group 1 in whom gynecomastia or breast pain developed were subsequently randomized to receive tamoxifen or RT soon after symptoms started. Gynecomastia, breast pain, prostate specific antigen, QOL, sexual function and hormonal levels were assessed. Minimum followup was 12 months.Results: Of group 1 patients 67% had gynecomastia compared with 8% in group 2 and 34% in group 3. Breast pain was more frequent in group 1 than in groups 2 and 3 (58% vs 7% and 30%, respectively). Differences were significant between groups 1 and 2 (OR 0.12 p Ͻ0.001), and groups 1 and 3 (OR 0.52 p Ͻ0.01). In patients in group 1 who had gynecomastia or breast pain a significant decrease in symptoms was achieved in those receiving tamoxifen (p Ͻ0.05). Treatments were well tolerated in the 3 groups. No differences in QOL between groups 2 and 3 were found. At a median followup of 26 months we observed 12 biochemical relapses.Conclusions: Gynecomastia and breast pain induced by bicalutamide monotherapy after RP can be prevented and treated. Tamoxifen has been shown to be more effective and safe than RT in this setting. QOL and sexual function are not negatively influenced by these 2 treatment options.

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“…Lokalize prostat kanseri nedeniyle Radikal Prostatektomi (RP) uygulanan olguların yaklaşık 1/3'ünde on yıl içinde nüks gelişmektedir (1,2). Nüksler operasyon yerindeki kalıntı subklinik hastalığa veya prostatektomi sırasında mevcut gizli metastatik hastalığa bağlı olup zaman içinde Prostat Spesifik Antijen'de (PSA) yükselme, lokal nüks veya uzak metastazlarla kendini gösterir.…”

Section: Introductionunclassified

AUA/ASTRO 2013 Guidelines for Adjuvant and Salvage Radiation Therapy After Prostatectomy: What are the Yields and the Changes?

Yaman¹

2015

uob

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Long-Term Hazard of Progression After Radical Prostatectomy for Clinically Localized Prostate Cancer: Continued Risk of Biochemical Failure After 5 Years

Cited by 79 publications

References 22 publications

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Gynecomastia and Breast Pain Induced by Adjuvant Therapy With Bicalutamide After Radical Prostatectomy in Patients With Prostate Cancer: The Role of Tamoxifen and Radiotherapy

AUA/ASTRO 2013 Guidelines for Adjuvant and Salvage Radiation Therapy After Prostatectomy: What are the Yields and the Changes?

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