Long-Term Survival Probability in Men With Clinically Localized Prostate Cancer: A Case-Control, Propensity Modeling Study Stratified by Race, Age, Treatment and Comorbidities

Tewari, Ashutosh; Johnson, Christine Cole; Divine, George; Crawford, E. David; Gamito, Eduard J.; Demers, Raymond Y.; Menon, Mani

doi:10.1097/01.ju.0000117975.40782.95

Cited by 153 publications

(102 citation statements)

References 17 publications

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“…In survival analyses, these men had a 70% probability of nonprostate cancer mortality at 10 years after treatment; this is commensurate with published estimates of long-term nonprostate mortality associated with Charlson scores !3. [16][17][18] In contrast, the risk of prostate cancer mortality was extremely low in our cohort over the period of follow-up (2 of 509 men; (<1%). This low mortality rate is consistent with those reported from large retrospective cohort studies of men with untreated, low-risk disease.…”

Section: Discussionmentioning

confidence: 66%

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: Discussionmentioning

confidence: 66%

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

Daskivich

Chamie

Kwan

et al. 2010

Cancer

127

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“…The accuracy of these graphs is unclear (ie, their discrimination and calibration): they are only for men aged 55-75 and they do not incorporate prostate-specific antigen (PSA), an important predictor of disease progression after surgery or radiation. 3,4 Tewari et al 5 produced prediction tables that can be applied to men treated with watchful waiting. However, the calibration of these predictions is unknown, and only 467 men in their dataset were treated with watchful waiting.…”

Section: Resultsmentioning

confidence: 99%

Nomogram incorporating PSA level to predict cancer‐specific survival for men with clinically localized prostate cancer managed without curative intent

Kattan

Cuzick

Fisher

et al. 2007

Cancer

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BACKGROUND. The prognosis of men with clinically localized prostate cancer is highly variable, and it is difficult to counsel a man who may be considering avoiding, or delaying, aggressive therapy. After collecting data on a large cohort of men who received no initial active prostate cancer therapy, the aim was to develop, and to internally validate, a nomogram for prediction of disease‐specific survival. METHODS. Working with 6 cancer registries within England and numerous hospitals in the region, a population‐based cohort of men diagnosed with prostate cancer between 1990 and 1996 was constructed. All men had baseline serum prostate‐specific antigen (PSA) measurements, centralized pathologic grading, and centralized review of clinical stage assignment. Based on the clinical and pathologic data from 1911 men, a statistical model was developed and validated that served as the basis for the nomogram. The discrimination and calibration of the nomogram were assessed with use of one‐third of the men, who were omitted from modeling and used as a test sample. RESULTS. The median age of the included men was 70.4 years. The 25th and 75th percentiles of PSA were 7.3 and 32.6 ng/mL respectively, and the median was 15.4 ng/mL. Forty‐two percent of the men had high‐grade disease. The nomogram predicted well, with a concordance index of 0.73, and had good calibration. CONCLUSIONS. An accurate tool was developed for predicting the probability that a man with clinically localized prostate cancer will survive his disease for 120 months if the cancer is not treated with curative intent immediately. The tool should be helpful for patient counseling and clinical trial design. Cancer 2008. © 2007 American Cancer Society.

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“…Tewari et al [26] presented lookup tables to estimate survival probability of men with clinically localized pro state cancer stratified by patient age, race, Charlson comorbidity and treatment type. Although the Charlson score is probably the most frequently used measurement of npg comorbidities in the context of RP, in our study, Charlson score did not influence the outcome of patients with clinical locally advanced prostate cancer.…”

Section: The Influence Of Charlson Score On Survival Outcomesmentioning

confidence: 99%

Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

Hsu¹,

Joniau²,

Oyen³

et al. 2008

Asian J Androl

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According to the European Association of Urology (EAU) guidelines, a life expectancy of > 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (< 65 and ≥ 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and ≥ 1). Both age and Charlson score were analyzed regarding their predictive power of patients' outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were < 65 years old and 94 patients were ≥ 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of ≥ 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age-and comorbidity-dependent.

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Long-Term Survival Probability in Men With Clinically Localized Prostate Cancer: A Case-Control, Propensity Modeling Study Stratified by Race, Age, Treatment and Comorbidities

Abstract: These lookup tables provide physicians and patients with realistic estimates of 10-year survival and allow them to compare the impact of cancer vs noncancer factors on patient mortality.

Cited by 153 publications

References 17 publications

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

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

Nomogram incorporating PSA level to predict cancer‐specific survival for men with clinically localized prostate cancer managed without curative intent

Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

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