Trends in Metastatic Breast and Prostate Cancer — Lessons in Cancer Dynamics

Welch, H. Gilbert; Gorski, David H.; Albertsen, Peter C.

doi:10.1056/nejmp1510443

Cited by 171 publications

(108 citation statements)

References 5 publications

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“…[1][2][3][4] However, PSA screening is associated with overdiagnosis and overtreatment, and it is controversial whether it does more good than harm. 5,6 Smarter screening strategies are needed to improve the accuracy of diagnosing lethal PCa while minimizing harms associated with overdiagnosis and overtreatment of indolent cancer.…”

Section: Introductionmentioning

confidence: 99%

Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer

Preston

Batista

Wilson

et al. 2016

JCO

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Purpose Prostate-specific antigen (PSA) level in midlife predicted future prostate cancer (PCa) mortality in an unscreened Swedish population. Our purpose was to determine if a baseline PSA level during midlife predicts lethal PCa in a US population with opportunistic screening. Materials and Methods We conducted a nested case-control study among men age 40 to 59 years who gave blood before random assignment in the Physicians’ Health Study, a randomized, placebo-controlled trial of aspirin and β-carotene among 22,071 US male physicians initiated in 1982 and then transitioned into a prospective cohort with 30 years of follow-up. Baseline PSA levels were available for 234 patients with PCa and 711 age-matched controls. Seventy-one participants who developed lethal PCa were rematched to 213 controls. Conditional logistic regression was used to estimate odds ratios and the area under the receiver operating characteristic curve, with 95% CIs, of the association between baseline PSA and risk of lethal PCa. Results Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. Risk of lethal PCa was strongly associated with baseline PSA in midlife: odds ratios (95% CIs) comparing PSA in the > 90th percentile versus less than or equal to median were 8.7 (1.0 to 78.2) at 40 to 49 years, 12.6 (1.4 to 110.4) at 50 to 54 years, and 6.9 (2.5 to 19.1) at 55 to 59 years. A total of 82%, 71%, and 86% of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively. Conclusion PSA levels in midlife strongly predict future lethal PCa in a US cohort subject to opportunistic screening. Risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.

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Section: Introductionmentioning

confidence: 99%

Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer

Preston

Batista

Wilson

et al. 2016

JCO

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“…Establishing a diagnosis of cancer before the operation is considered to lead to oncologically more adequate surgical interventions and improved cure rates (1). An assumption underlying many screening programs is that detection of subclinical, asymptomatic disease at the beginning of the cancer growth trajectory of sequential spread of cancer from a single focus to lymph nodes and distant organs allows for surgical removal of the tumor before it spreads further to produce clinical signs and symptoms (2).…”

Section: Introductionmentioning

confidence: 99%

Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening

Machens

Dralle

2016

European Journal of Endocrinology

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Objective: Time trends of the extent of disease at first diagnosis and biochemical cure remain ill-defined for sporadic medullary thyroid cancer (MTC). This investigation aimed to delineate time trends and biochemical cure rates for sporadic MTC. Design: This was an observational study of consecutive patients operated on for sporadic MTC between 1995 and 2015. Methods: Time trends of clinical and histopathological variables indicative of the extent of disease and biochemical cure were calculated for 600 patients with sporadic MTC, 322 of whom had initial neck surgery and 278 of whom had neck reoperation at a tertiary surgical center in Germany. Results: From 1995-2000 to 2011-2015, significant declines (all P < 0.001) were noted in the percentage of node-positive tumors (from 73 to 49%), mediastinal lymph node metastasis (from 21 to 6%) and distant metastasis (from 23 to 6%). These changes were paralleled by significant increases (all P < 0.001) in mean patient age (from 49.1 to 57.3 years) and the percentage of MTC ≤10 mm (from 19 to 39%) and biochemical cure (from 28 to 62%). When only patients with primary tumors >10 mm were considered, the decreasing percentage of mediastinal lymph node metastasis and distant metastasis, and rising mean patient age and biochemical cure rates remained statistically significant. Conclusions: Significant reductions in the extent of the disease and improved biochemical cure rates pointed toward increasing therapeutic control of sporadic MTC. The independent contribution of routine calcitonin screening to these time-dependent changes warrants more research.

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“…This therapy was initially used for the treatment of prostate cancer and has also been investigated in the treatment of other solid tumors in recent decades [7][8][9][10]. There are studies documenting its efficacy in terms of local tumor control [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Iodine-125 Seed Implantation in Locoregionally Recurrent and Unresectable Breast Cancer: a Retrospective Study

Wei

Qin

et al. 2017

Pathol. Oncol. Res.

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The management of locoregionally recurrent and unresectable breast cancer is a therapeutic challenge. This retrospective study aimed to assess the efficacy of 125 I seed implantation brachytherapy as a palliative management in locoregionally recurrent breast cancer. We analyzed 36 locoregionally recurrent and unresectable breast cancers in our hospital between 2012 and 2016. All patients were treated with CT-guided 125 I seed permanent implantation. The dose distribution of 125 I seeds was calculated using a computerized treatment planning system. Complete response, partial response, stable disease, and local tumor control rates were calculated. Long-term efficacy was assessed based on survival rates ranging from 1 to 4 years. The follow-up period ranged from 6 to 53 months. The median local control was 28 months (95% CI: 16.2-39.8 months). The percentage of patients who showed 6-month, 1-year, 2-year, and 3-year local control was 97.2%, 77.8%, 52.8%, and 33.3%, respectively. Median survival time for all patients was 48 months (95% CI: 40.9-55.1 months); 1-year, 2-year, 3-year, and 4-year survival rates were 97.2%, 80.6%, 63.9%, and 46.5%, respectively. Pain relief response rate was 88.9%. No serious complications were detected during the follow-up period. The results of this study demonstrate that 125 I seed implantation could be considered a feasible and promising minimally invasive therapy for locoregionally recurrent and unresectable breast carcinoma.

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Trends in Metastatic Breast and Prostate Cancer — Lessons in Cancer Dynamics

Cited by 171 publications

References 5 publications

Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer

Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer

Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening

Efficacy of Iodine-125 Seed Implantation in Locoregionally Recurrent and Unresectable Breast Cancer: a Retrospective Study

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