Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer

Bill‐Axelson, Anna; Holmberg, Lars; Ruutu, Mirja; Garmo, Hans; Stark, Jennifer R.; Busch, Christer; Nordling, Stig; Häggman, Michael; Andersson, Swen‐Olof; Bratell, Stefan; Spångberg, Anders; Palmgren, Juni; Steineck, Gunnar; Adami, Hans‐Olov; Johansson, Jan‐Erik

doi:10.1056/nejmoa1011967

Cited by 1,041 publications

(477 citation statements)

References 17 publications

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“…These men are unlikely to realize a prostate-cancer survival benefit with aggressive treatment. 37,38 Consequently, treatment recommendations are predicated on whether the patient can be expected to have a 10-year to 15-year life expectancy. 2,3 Although competing risks of mortality for men with localized prostate cancer are well recognized, 38,39 clinicians often poorly estimate life expectancy.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of men in PCOS underwent radical prostatectomy, which has been shown to reduce prostate cancer mortality in men with higher-risk cancers. 37,44 Treatment recommendations have changed over the past few decades, and more men with localized prostate cancers are being encouraged to consider observation. 2 This could mean higher prostate-cancer mortality rates, though that would differentially impact men reporting excellent health rather than poor health, because the latter would not 45 and the proportion of prostate cancer deaths was quite small.…”

Section: Discussionmentioning

confidence: 99%

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Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

et al. 2015

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BACKGROUND: Guidelines recommend against treating localized prostate cancer (PCa) in men with a greater than10-year life expectancy. However, physicians have difficulty accurately estimating life expectancy. OBJECTIVE: We used data from a population-based observational study to develop a nomogram to estimate long-term other-cause mortality based on self-reported health status (SRHS), race/ethnicity, and age at diagnosis. DESIGN: This was an observational study. SUBJECTS: Men diagnosed with localized PCa from October 1994 through October 1995 participated in the study. MAIN MEASURES: Initial measures obtained 6 months after diagnosis included sociodemographic and tumor characteristics, treatment, and a single item on the SRHS, with response options ranging from excellent to poor. We used Surveillance, Epidemiology, and End-Results program data to determine date and cause of death through December 2010. We estimated other-cause mortality with proportional hazards survival analyses, accounting for competing risks. KEY RESULTS: We evaluated 2,695 men, of whom 74 % underwent aggressive therapy (surgery or radiotherapy). At the initial survey, 18 % reported excellent (E), 36 % very good (VG), 31 % good (G), and 15 % fair/poor (F/P) health. Healthier men were younger, and more likely to be white, better educated, and to undergo surgery. At follow-up, 44 % of the cohort had died; 78 % of deaths were from causes other than PCa. SRHS predicted other-cause mortality; for men reporting E, VG, G, F/P health, the cumulative incidences of other-cause mortality were 20 %, 29 %, 40 %, and 53 %, respectively, p<0.001. Compared to a reference of excellent SRHS, multivariable hazard ratios (95 % CI) for other-cause mortality for men reporting VG, G, and F/P health were 1.22 (0

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

et al. 2015

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“…These trends are attributed to the widespread use of prostate specific antigen (PSA) testing, which has resulted in men being diagnosed with prostate cancer at a younger age, and with less advanced disease [3][4] , ageing populations and improved survival [5][6][7] . There is no consensus on the optimum treatment of men with localised disease [8,9] . Radical prostatectomy and radiotherapy are the most commonly used treatments for localised prostate cancer; active surveillance or watchful waiting are appropriate management strategies in some cases, and brachytherapy is becoming more common.…”

Section: Introductionmentioning

confidence: 99%

“…Each treatment carries the potential for general and disease-specific adverse effects or symptoms, which can be acute or chronic, lasting throughout survivorship [3,10,11] . These symptoms can negatively affect the global health-related quality of life (HRQoL) of men with prostate cancer [3,8,10,12] and are associated with increased risks of depression, anxiety and distress among survivors [20] . Much of the focus has been on the physical disease-specific symptoms including urinary incontinence, sexual dysfunction and bowel problems experienced by men with prostate cancer, while more general symptoms including insomnia have received less attention in this patient group [3,8,10,11,14] .…”

Section: Introductionmentioning

confidence: 99%

Are we sleeping on the job? Insomnia among men with prostate cancer

Drummond

2016

Adv Mod Oncol Res

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Prostate cancer is one of the most commonly diagnosed cancers in men and almost half of male cancer survivors in the US have had a prostate cancer diagnosis. Insomnia is common among cancer patients and survivors. There is evidence that cognitive behavioural therapy can be used to effectively manage insomnia among women with breast cancer. The aim of this review was to investigate the prevalence, risk factors and management of insomnia among men with prostate cancer. The effect of insomnia on the psychological health and health-related quality of life of these patients and/or survivors is also discussed. Increased awareness and knowledge of this symptom among men with prostate cancer may facilitate improved diagnosis, and management of insomnia in this large population. This in turn may improve the health-related quality of life of these men. Therefore, research into the effective management of insomnia among men with prostate cancer is essential.Keywords: prostate cancer; insomnia; androgen deprivation therapy; radiotherapy; health-related quality of life; depression; anxiety

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“…At 10 years, it offers more survival benefit than SPCG4 documented for radical prostatectomy over watchful waiting (8% vs. 5%). 2,13 We have a tremendous opportunity to make a meaningful difference in the lives of our patients and the healthcare system -we just need to listen to the evidence and act accordingly.…”

Section: Andrew Loblaw MD Frcpcmentioning

confidence: 99%

Opportunity lost and found: Any easy way to improve outcomes for prostate cancer patients in the postoperative setting?

Loblaw¹

2013

CUAJ

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E vidence-based medicine is a paradigm shift and is a key component in the provision of high-quality care. The highest quality evidence is clinical practice guidelines based on systematic reviews of the randomized controlled trial (RCT) literature. There are many challenges to successfully complete RCTs and it is problematic to synthesize recommendations when the RCTs have conflicting results.However, in the case of the utility of adjuvant postoperative radiotherapy (ART), this is not the case. There are three RCTs showing improvements in local and biochemical control; 1-3 the study with the longest follow-up (SWOG 8794) also demonstrates improvements in distant metastatic disease-free survival and overall survival. 2 Cancer Care Ontario (CCO) published a systematic review of the literature and clinical practice guideline on the topic showing that all subgroups benefitted in biochemical control and overall survival from ART (and those with seminal vesicle involvement seemed to benefit more not less). 4 It is very interesting to see how this evidence is applied in the pragmatic setting. In this issue of CUAJ, Tyldesley and colleagues have published a population-based analysis of postoperative radiotherapy in British Columbia from 2007 to 2009. 5 Many interesting facts are reported. Over the 3-year observation period, 9223 patients were identified from the tumour registry and linked to centralized radiotherapy records. Of these patients, initial therapy was radical prostatectomy in 24%. Postoperatively, 47% had one or more highrisk features (positive surgical margin: 36%; extracapsular spread: 22%; seminal vesicle involvement: 4%). 5 Of the 47% with one or more high-risk features, 23% with any adverse features were seen by a radiation oncologist within 6 months of surgery. Only 10% of these patients received adjuvant ART (i.e., 2% of patients with any highrisk features). Of equal interest, 40% of those with adverse features who were seen were advised against ART.Why are the rates of referral (23%) and recommendation (60%) and use of ART (2%) so low for these patients?The first argument is a lack of knowledge. The EORTC and SWOG studies were published in 2005 and 2006, respectively (and all were presented in abstract before the observation period). Despite this, we know that evidence takes a while to diffuse into practice, particularly community practice. How long is too long when we have a treatment with a solid evidence base that improves not just biochemical, but distant metastatic disease and overall survival rates? Is there anything we could have done differently to accelerate this knowledge dissemination?The second argument is that the treatment is too toxic. It is easy to attribute really bad side effects (such as severe hemorrhagic cystitis) to all patients who might get radiation. However, when prospectively collected, the data demonstrate that the risk of serious RT toxicity was low. In the Wiegel trial, 1% and 0% of patients had grade 3 bladder and bowel problems. 3 This is despite patients receiving 2-d...

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Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer

Abstract: Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment. (Funded by the Swedish Cancer Society and the National Institutes of Health.).

Cited by 1,041 publications

References 17 publications

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Are we sleeping on the job? Insomnia among men with prostate cancer

Opportunity lost and found: Any easy way to improve outcomes for prostate cancer patients in the postoperative setting?

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