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1.
Melissa Assel Anders Dahlin David Ulmert Anders Bergh Pär Stattin Hans Lilja Andrew J. Vickers 《European urology》2018,73(6):961-967
Background
Lead time (LT) is of key importance in early detection of cancer, but cannot be directly measured. We have previously provided LT estimates for prostate cancer (PCa) using archived blood samples from cohorts followed for many years without screening.Objective
To determine the association between LT and PCa grade at diagnosis to provide an insight into whether grade progresses or is stable over time.Design, setting, and participants
The setting was three long-term epidemiologic studies in Sweden including men not subject to prostate-specific antigen (PSA) screening. The cohort included 1041 men with PSA of 3–10 ng/ml at blood draw and subsequently diagnosed with PCa with grade data available.Outcome measurements and statistical analysis
Multivariable logistic regression was used to predict high-grade (Gleason grade group ≥2 or World Health Organization grade 3) versus low-grade PCa at diagnosis in terms of LT, defined as the time between the date of elevated PSA and the date of PCa diagnosis with adjustment for cohort and age.Results and limitations
The probability that PCa would be high grade at diagnosis increased with LT. Among all men combined, the risk of high-grade disease increased with LT (odds ratio 1.13, 95% confidence interval [CI] 1.10–1.16; p < 0.0001), with no evidence of differences in effect by age group or cohort. Higher PSA predicted shorter LT by 0.46 yr (95% CI 0.28–0.64; p < 0.0001) per 1 ng/ml increase in PSA. However, there was no interaction between PSA and grade, suggesting that the longer LT for high-grade tumors is not simply related to age. Limitations include the assumption that men with elevated PSA and subsequently diagnosed with PCa would have had biopsy-detectable PCa at the time of PSA elevation.Conclusions
Our data support grade progression, whereby following a prostate over time would reveal transitions from benign to low-grade and then high-grade PCa.Patient summary
Men with a longer lead time between elevated prostate-specific antigen and subsequent prostate cancer diagnosis were more likely to have high-grade cancers at diagnosis. 相似文献2.
Sigrid Carlsson Melissa Assel David Ulmert Axel Gerdtsson Jonas Hugosson Andrew Vickers Hans Lilja 《European urology》2017,71(1):46-52
Background
Current prostate cancer screening guidelines conflict with respect to the age at which to initiate screening.Objective
To evaluate the effect of prostate-specific antigen (PSA) screening versus zero screening, starting at age 50–54 yr, on prostate cancer mortality.Design, setting, and participants
This is a population-based cohort study comparing 3479 men aged 50 yr through 54 yr randomized to PSA-screening in the Göteborg population-based prostate cancer screening trial, initiated in 1995, versus 4060 unscreened men aged 51–55 yr providing cryopreserved blood in the population-based Malmö Preventive Project in the pre-PSA era, during 1982–1985.Outcome measurements and statistical analysis
Cumulative incidence and incidence rate ratios of prostate cancer diagnosis, metastasis, and prostate cancer death.Results and limitations
At 17 yr, regular PSA-screening in Göteborg of men in their early 50s carried a more than two-fold higher risk of prostate cancer diagnosis compared with the unscreened men in Malmö (incidence rate ratio [IRR] 2.56, 95% confidence interval [CI] 2.18, 3.02), but resulted in a substantial decrease in the risk of metastases (IRR 0.43, 95% CI 0.22, 0.79) and prostate cancer death (IRR 0.29, 95% CI 0.11, 0.67). There were 57 fewer prostate cancer deaths per 10 000 men (95% CI 22, 92) in the screened group. At 17 yr, the number needed to invite to PSA-screening and the number needed to diagnose to prevent one prostate cancer death was 176 and 16, respectively. The study is limited by lack of treatment information and the comparison of the two different birth cohorts.Conclusions
PSA screening for prostate cancer can decrease prostate cancer mortality among men aged 50–54 yr, with the number needed to invite and number needed to detect to prevent one prostate cancer death comparable to those previously reported from the European Randomized Study of Screening for Prostate Cancer for men aged 55–69 yr, at a similar follow-up. Guideline groups could consider whether guidelines for PSA screening should recommend starting no later than at ages 50–54 yr.Patient summary
Guideline recommendations about the age to start prostate-specific antigen screening could be discussed. 相似文献3.
Brent K. Hollenbeck Samuel R. Kaufman Phyllis Yan Lindsey A. Herrel Tudor Borza Florian R. Schroeck Bruce L. Jacobs Ted A. Skolarus Vahakn B. Shahinian 《European urology》2018,73(4):491-498
Background
Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.Objective
To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.Design, setting, and participants
A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.Intervention
Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.Outcome measurements and analysis
Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.Results
Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.Conclusions
Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.Patient summary
We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient. 相似文献4.
D.E. Orakwe K.H. Tijani E.A. Jeje M.A. Ogunjimi R.W. Ojewola 《The African Journal of Urology》2017,23(2):105-108
Objectives
To compare serum testosterone and prostate specific antigen (PSA) levels of patients diagnosed of prostate cancer to those with benign prostatic hyperplasia (BPH).Subjects and methods
One hundred and thirteen male patients with or without LUTS who had indication(s) for prostate biopsies were recruited. Blood samples were analysed for serum testosterone and serum PSA. Prostate sizes were measured and PSA densities calculated before trans-rectal prostate biopsies were performed.Results
On histology of prostate biopsy specimens, 54 patients (47.8%) had prostate adenocarcinoma while 59 patients (52.2%) had BPH. Serum testosterone levels were lower in the prostate cancer group (23.09 ± 2.31 nmol/L versus 24.37 ± 1.94 nmol/L in the BPH group) but this difference was not statistically significant (p = 0.671). Serum testosterone also did not differ significantly with Gleason grade and Gleason score in patients with prostate cancer.Serum PSA and PSA density (PSAD) values were significantly higher in men with prostate cancer, and also in prostate cancer patients with high grade disease.Conclusion
Serum testosterone levels of patients with prostate cancer did not significantly differ from those of patients with BPH and were not related to grade in prostate cancer patients. 相似文献5.
Antoine Kass-Iliyya Gordana Jovic Claire Murphy Cyril Fisher Isabel Syndikus Chakiath Jose Christopher D. Scrase John D. Graham David Nicol Matthew R. Sydes David Dearnaley 《European urology》2018,73(6):968-976
Background
The importance of 2-yr postradiotherapy prostate biopsy status remains uncertain.Objective
To assess the value of 2 year post treatment biopsies in a randomised trial of radiotherapy dose escalation.Design, setting, and participants
Between 1998 and 2001, 843 men with localised prostate cancer were randomised to receive either control-64 Gy or escalated-74 Gy conformal radiotherapy (CFRT) in the MRC RT01 trial in combination with 3–6-mo neoadjuvant androgen deprivation therapy. Prostate biopsies were planned at 2 yr from start of CFRT in suitable men.Outcome measurements and statistical analysis
Prostate biopsy results and prostate-specific antigen (PSA) levels performed at 2 yr post-CFRT were evaluated with long-term biochemical progression free survival (bPFS) and overall survival. Outcome measures were timed from the 2-yr biopsy using a landmark approach.Results and limitations
A 2-yr biopsy was performed in 312/843 patients. One hundred and seventy-seven patients were included in the per-protocol group with median follow-up of 7.8 yr from biopsy. Median PSA at biopsy was 0.5 ng/ml. Sixty-four bPFS events were reported: 46/145 (32%) in patients with negative, 6/18 (33%) suspicious, and 12/14 (86%) positive biopsies. A positive biopsy was prognostic of worse bPFS, going forward, compared with negative and suspicious biopsies, hazard ratio (HR) = 4.81 (95% confidence interval [CI]: 2.50–9.26, p < 0.001). The estimate for survival was HR = 1.58 (95% CI: 0.52–4.78, p = 0.42). PSA values at 2 yr between 1.01 ng/ml and 2.09 ng/ml were also associated with subsequent PSA failures (HR = 2.71, 95% CI: 1.98–3.71), bPFS events (HR = 2.45, 95% CI: 1.81–3.32), and prostate cancer-specific survival (HR = 2.87, 95% CI: 1.08–7.64) compared with PSA ≤1.0 ng/ml.Conclusions
Two-year postradiotherapy prostate biopsies have limited value in patients with PSA control but both positive biopsy and higher PSA status are strongly associated with future bPFS events. A policy of selected biopsy may provide an opportunity for early salvage interventions.Patient summary
Routine 2-yr postradiotherapy biopsy is not recommended but can be considered in selected patients with unfavourable post-treatment prostate-specific antigen levels who are suitable for early salvage treatments. 相似文献6.
K.H. Tijani C.C. Anunobi A.O. Adeyomoye T.O. Alabi A.O. Lawal N.O. Akanmu R.W. Ojewola O.O. Soriyan 《The African Journal of Urology》2017,23(1):14-19
Introduction
In Western and Asian literature, the measurement of percentage free prostate specific antigen (%fPSA) has been known to enhance the predictive role of total prostate specific antigen (tPSA) in early prostate cancer (Ca-P) detection. Relationship between the tPSA and Ca-P are known to be influenced by race. To the best of our knowledge, the relationship between %fPSA and Ca-P has not been studied in sub-Saharan Africa using current established biopsy protocol.Objective
To evaluate the usefulness of %fPSA in indigenous West African men and determine the appropriate cut-off values that may be used as indication for prostate biopsy in men with tPSA of 4–10 ng/ml.Subjects and methods
A total 169 consecutive patients with tPSA of 4–10 ng/ml with non-suspicious findings on digital rectal examination (DRE) had a transrectal ultrasound (TRUS) guided 10-core prostate biopsy. The technique of PSA analysis was the Access hybritech assay technique using the Beckman's Access autoimmuno analyser. The rates of prostate cancer in different %fPSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate the efficiency of %fPSA in the diagnosis of prostate cancer.Results
A reduction %fPSA was associated with a higher detection rate of Ca-P. There was a 62% prevalence of Ca-P with %fPSA ≤ 10% while there was a zero prevalence in patients with fPSA above 20%. At a %fPSA cut off of 20% the sensitivity and specificity were 100% and 45%, respectively. Using the ROC curve, the area under the curve (AUC) was 0.76 while the ROC decision plot showed that a %fPSA cut off 15% was associated with the highest ability to discriminate between benign and malignant diseases.Conclusion
The %fPSA is an effective discriminating tool in determining the need for prostate biopsy in indigenous West African men with PSA 4–10 ng/ml. A cut off of 15% was associated with the highest performance. 相似文献7.
F.A. Yeboah E. Acheampong C.K. Gyasi-Sarpong K. Aboah E.F. Laing C. Obirikorang B.T. Frimpong G. Amoah E.N. Batu E.O. Anto B. Amankwaah 《The African Journal of Urology》2018,24(1):45-53
Introduction and objectives
Several existing models have been developed to predict positive prostate biopsy among men undergoing evaluation for prostate cancer (PCa). However, most of these models have come from industrialized countries. We therefore, developed a prostate disease nomogram model to provide a basis for predicting a prostate biopsy outcome by correlating clinical indicators and diagnostic parameters among Ghanaian men.Subjects and methods
The study was a hospital-based cross-sectional prospective one which was undertaken at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to March, 2016. In all a total of 241 patients suspected of having a prostate disorder due based on an abnormal digital rectal examination (DRE) findings and, or elevated prostate specific antigen (PSA) level underwent Trans-Rectal Ultrasonography (TRUS) guided biopsy of the prostate. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), digital rectal examination (DRE) status, prostate specific antigen density (PSAD), history of alcohol consumption and history of smoking findings were included in the analysis. Two nomogram models were developed that were based on these independent predictors to estimate the probability of a positive initial prostate biopsy. Receiver-operating characteristic curves (ROC) were used to assess the accuracy of using the nomograms and PSA and PSAD levels for predicting positive a prostate biopsy outcome.Results
Prostate cancer was diagnosed in 63 out of 241 patients (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) of patients and the remaining 6 patients (2.48%) had chronic inflammation. Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa (p < 0.05). Furthermore, it was observed that age, DRE, PSA, PSAD, history of smoking, and history of alcohol consumption were significantly independent predictors (p < 0.05) of prostate cancer. The area under the receiver operating characteristic curve (AUC) of nomogram I and II were 87.3 and 84.8 respectively which were greater than that of total PSA (AUC = 75.8) and PSAD (AUC = 77.8) alone for predicting a positive initial prostate biopsyConclusion
We conclude that, nomograms offer a better and accurate assessment for predicting a positive outcome of prostate biopsies than the use of traditional tools of PSA, DRE and PSAD alone. 相似文献8.
Vidit Sharma Avinash Nehra Michele Colicchia Mary E. Westerman Akira Kawashima Adam T. Froemming Eugene D. Kwon Lance A. Mynderse R. Jeffrey Karnes 《European urology》2018,73(6):879-887
Background
The Stephenson nomogram is widely used to estimate the success of salvage radiotherapy (sXRT) for prostate cancer (PCa) recurrence after radical prostatectomy (RP).Objective
To determine whether multiparametric pelvic magnetic resonance imaging (mpMRI) performed for biochemical recurrence after RP improves prognostication of sXRT relative to the Stephenson nomogram.Design, setting, and participants
Men undergoing RP at our institution from 2003 to 2012 who had biochemical recurrence evaluated by mpMRI within 12 mo of sXRT were retrospectively reviewed. Exclusion criteria included PCa treatment prior to RP, adjuvant XRT after RP, salvage cryotherapy before sXRT, and hormone refractory disease prior to sXRT.Outcome measurements and statistical analysis
Multivariable Cox regression analyses (adjusting for Stephenson nomogram covariates) associated mpMRI findings with prostate-specific antigen (PSA) recurrence and metastasis after sXRT. The mpMR images were compared in a binary fashion: no lesion versus vesicourethral/seminal vesical bed/prostate fossa lesions.Results and limitations
Among 473 sXRT patients, 57%(204) had lesions on mpMRI: 26%(124) vesicourethral, 28%(135) seminal vesical bed/prostatic fossa, 7%(34) nodal, and 1%(3) bone. Median PSA at mpMRI with lesions was 0.46 versus 0.40 ng/ml without lesions. After excluding nodal/bone lesions, 29% of men developed PSA recurrence and 14% metastasis (median follow-up 45 mo after sXRT). For patients with a pre-sXRT PSA of ≤0.5 ng/ml, negative mpMRI was associated with increased PSA recurrence (39% vs 12%, p < 0.01) and metastasis (16% vs 2%, p < 0.01) at 4 yr after sXRT. For patients with a PSA of ≤0.5 ng/ml, the addition of mpMRI to the propensity score (created using variables from the original Stephenson nomogram) improved the c-statistic from 0.71 to 0.77 for PSA recurrence (hazard ratio [HR] 3.60, p < 0.01) and from 0.66 to 0.77 for metastasis (HR 6.68, p < 0.01). Limitations include evolutions in MRI technique and lack of a cohort of men undergoing mpMRI electing against sXRT.Conclusions
Pre-sXRT mpMRI improves clinicopathologic variables to estimate sXRT success, particularly in the early sXRT setting.Patient summary
Men who have biochemically recurrent prostate cancer after radical prostatectomy often receive salvage radiotherapy. In our study, multiparametric pelvic magnetic resonance imaging prior to salvage radiotherapy was a significant predictor of prostate-specific antigen failure and metastasis after radiotherapy. 相似文献9.
A. Sanchís-Bonet M. Barrionuevo-González A.M. Bajo-Chueca L. Pulido-Fonseca L.E. Ortega-Polledo J.C. Tamayo-Ruiz M. Sánchez-Chapado 《Actas urologicas espa?olas》2018,42(1):25-32
Objectives
To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[–2] pro prostate-specific antigen» using the prostate health index (PHI) in decision making for performing prostate biopsies.Material and methods
We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA). The PHI was calculated as p2PSA/fPSA × √tPSA. We created 2 predictive models that incorporated clinical variables along with tPSA or PHI. The performance of PHI was assessed with a discriminant analysis using receiver operating characteristic curves, internal calibration and decision curves.Results
The areas under the curve for the tPSA and PHI models were 0.71 and 0.85, respectively. The PHI model showed a better ability to discriminate and better calibration for predicting prostate cancer but not for predicting a Gleason score in the biopsy ≥7. The decision curves showed a greater net benefit with the PHI model for diagnosing prostate cancer when the probability threshold was 15-35% and greater savings (20%) in the number of biopsies.Conclusions
The incorporation of p2PSA through PHI in predictive models of prostate cancer improves the accuracy of the risk stratification and helps in the decision-making process for performing prostate biopsies. 相似文献10.
Won Sik Ham Heather J. Chalfin Zhaoyong Feng Bruce J. Trock Jonathan I. Epstein Carling Cheung Elizabeth Humphreys Alan W. Partin Misop Han 《European urology》2017,71(6):907-912
Background
The newly proposed five-tiered prostate cancer grading system (PCGS) divides Gleason score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes.Objective
To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS.Design, setting, and participants
Of 23 918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10.Outcome measures and statistical analysis
Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event.Results and limitations
Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p < 0.01) and RP GS (HR 2.38, 95% CI 1.74–3.28; p < 0.01). This association persisted in multivariable models after adjusting for perioperative variables.Conclusions
Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS.Patient summary
The prostate cancer grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason score 8–10 disease based on both biopsy and RP Gleason scores. There are significant differences in all-cause mortality and prostate cancer–specific mortality following surgery between men with Gleason score 8 and those with Gleason score 9–10 disease. 相似文献11.
Mark A. Preston Travis Gerke Sigrid V. Carlsson Lisa Signorello Daniel D. Sjoberg Sarah C. Markt Adam S. Kibel Quoc-Dien Trinh Mark Steinwandel William Blot Andrew J. Vickers Hans Lilja Lorelei A. Mucci Kathryn M. Wilson 《European urology》2019,75(3):399-407
Background
Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men.Objective
To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men.Design, setting, and participants
Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40–64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment.Outcome measurements and statistical analysis
Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA.Results and limitations
Median PSA among controls was 0.72, 0.80, 0.94, and 1.03 ng/ml for age groups 40–49, 50–54, 55–59, and 60–64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33 ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2–539) for 40–54 yr and 71.7 (95% CI, 23.3–288) for 55–64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3–infinity) for 40–54 yr and 51.8 (95% CI, 11.0–519) for 55–64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation.Conclusions
PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies.Patient summary
Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk. 相似文献12.
Nicola Fossati R. Jeffrey Karnes Michele Colicchia Stephen A. Boorjian Alberto Bossi Thomas Seisen Nadia Di Muzio Cesare Cozzarini Barbara Noris Chiorda Claudio Fiorino Giorgio Gandaglia Paolo Dell’Oglio Shahrokh F. Shariat Gregor Goldner Steven Joniau Antonino Battaglia Karin Haustermans Gert De Meerleer Alberto Briganti 《European urology》2018,73(3):436-444
Background
Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients.Objective
We aimed to identify the optimal candidates for early SRT after RP.Design, setting, and participants
The study included 925 node-negative patients treated with SRT after RP at seven institutions. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP that was defined as PSA level ≥0.1 ng/ml at 1 mo after surgery. All patients received local radiation to the prostate and seminal vesicle bed.Outcome measurements and statistical analysis
The primary outcome measured was distant metastasis after SRT. Regression tree analysis was used to develop a risk-stratification tool. Multivariable Cox regression analysis and nonparametric curve fitting methods were used to explore the relationship between PSA level at SRT and the probability of metastasis-free survival at 8 yr.Results and limitations
At a median follow-up of 8.0 yr, 130 patients developed distant metastasis. At multivariable analysis, pre-SRT PSA level was significantly associated with distant metastasis (hazard ratio: 1.06, p < 0.0001). However, when patients were stratified into five risk groups using regression tree analysis (area under the curve: 85%), early SRT administration provided better metastasis-free survival in three groups only: (1) low risk: undetectable PSA after RP, Gleason score ≤7, and tumour stage ≥pT3b, (2) intermediate risk: undetectable PSA after RP with Gleason score ≥8, (3) high risk: PSA persistence after RP with Gleason score ≤7.Conclusions
We developed an accurate risk stratification tool to facilitate the individualised recommendation for early SRT based on prostate cancer characteristics. Early SRT proved to be beneficial only in selected groups of patients who are more likely to be affected by clinically significant but not yet systemic recurrence at the time of salvage treatment administration.Patient summary
In patients affected by prostate cancer recurrence after radical prostatectomy, the early administration of salvage radiation therapy is beneficial only for selected subgroups of patients. In this study, these groups of patients were identified. 相似文献13.
Sam J. Egger Ross J. Calopedos Dianne L. O’Connell Suzanne K. Chambers Henry H. Woo David P. Smith 《European urology》2018,73(6):859-867
Background
Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.Objective
To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.Design, setting, and participants
The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.Outcome measurements and statistical analysis
Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.Results and limitations
At 9–11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD = 5.9; 95% confidence interval or CI [0.5, 11.3] and AMD = 5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD = 5.3; 95% CI [0.2, 10.3] and AMD = 7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD = –9.1; 95% CI [–16.3, –2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD = –16.8; 95% CI [–27.6, –6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.Conclusions
Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.Patient summary
This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes. 相似文献14.
James T. Kearns Anna V. Faino Lisa F. Newcomb James D. Brooks Peter R. Carroll Atreya Dash William J. Ellis Michael Fabrizio Martin E. Gleave Todd M. Morgan Peter S. Nelson Ian M. Thompson Andrew A. Wagner Yingye Zheng Daniel W. Lin 《European urology》2018,73(5):706-712
Background
Many patients who are on active surveillance (AS) for prostate cancer will have surveillance prostate needle biopsies (PNBs) without any cancer evident.Objective
To define the association between negative surveillance PNBs and risk of reclassification on AS.Design, setting, and participants
All men were enrolled in the Canary Prostate Active Surveillance Study (PASS) between 2008 and 2016. Men were included if they had Gleason ≤3 + 4 prostate cancer and <34% core involvement ratio at diagnosis. Men were prescribed surveillance PNBs at 12 and 24 mo after diagnosis and then every 24 mo.Outcome measurements and statistical analysis
Reclassification was defined as an increase in Gleason grade and/or an increase in the ratio of biopsy cores to cancer to ≥34%. PNB outcomes were defined as follows: (1) no cancer on biopsy, (2) cancer without reclassification, or (3) reclassification. Kaplan–Meier and Cox proportional hazard models were performed to assess the risk of reclassification.Results and limitations
A total of 657 men met inclusion criteria. On first surveillance PNB, 214 (32%) had no cancer, 282 (43%) had cancer but no reclassification, and 161 (25%) reclassified. Among those who did not reclassify, 313 had a second PNB. On second PNB, 120 (38%) had no cancer, 139 (44%) had cancer but no reclassification, and 54 (17%) reclassified. In a multivariable analysis, significant predictors of decreased future reclassification after the first PNB were no cancer on PNB (hazard ratio [HR] = 0.50, p = 0.008), lower serum prostate-specific antigen, larger prostate size, and lower body mass index. A finding of no cancer on the second PNB was also associated with significantly decreased future reclassification in a multivariable analysis (HR = 0.15, p = 0.003), regardless of the first PNB result. The major limitation of this study is a relatively small number of patients with long-term follow-up.Conclusions
Men who have a surveillance PNB with no evidence of cancer are significantly less likely to reclassify on AS in the PASS cohort. These findings have implications for tailoring AS protocols.Patient summary
Men on active surveillance for prostate cancer who have a biopsy showing no cancer are at a decreased risk of having worse disease in the future. This may have an impact on how frequently biopsies are required to be performed in the future. 相似文献15.
R. Jeffrey Karnes Voleak Choeurng Ashley E. Ross Edward M. Schaeffer Eric A. Klein Stephen J. Freedland Nicholas Erho Kasra Yousefi Mandeep Takhar Elai Davicioni Matthew R. Cooperberg Bruce J. Trock 《European urology》2018,73(2):168-175
Background
Risk of prostate cancer-specific mortality (PCSM) is highly variable for men with adverse pathologic features at radical prostatectomy (RP); a majority will die of other causes. Accurately stratifying PCSM risk can improve therapy decisions.Objective
Validate the 22 gene Decipher genomic classifier (GC) to predict PCSM in men with adverse pathologic features after RP.Design, setting, and participants
Men with adverse pathologic features: pT3, pN1, positive margins, or Gleason score > 7 who underwent RP in 1987–2010 at Johns Hopkins, Cleveland Clinic, Mayo Clinic, and Durham Veteran's Affairs Hospital. We also analyzed subgroups at high risk (prostate-specific antigen > 20 ng/ml, RP Gleason score 8–10, or stage > pT3b), or very high risk of PCSM (biochemical recurrence in < 2 yr [BCR2], or men who developed metastasis after RP [MET]).Outcome measurements and statistical analysis
Logistic regression evaluated the association of GC with PCSM within 10 yr of RP (PCSM10), adjusted for the Cancer of the Prostate Risk Assessment Postsurgical Score (CAPRA-S). GC performance was evaluated with area under the receiver operating characteristic curve (AUC) and decision curves.Results and limitations
Five hundred and sixty-one men (112 with PCSM10), median follow-up 13.0 yr (patients without PCSM10). For high GC score (> 0.6) versus low-intermediate (≤ 0.6), the odds ratio for PCSM10 adjusted for CAPRA-S was 3.91 (95% confidence interval: 2.43–6.29), with AUC = 0.77, an increase of 0.04 compared with CAPRA-S. Subgroup odds ratios were 3.96, 3.06, and 1.95 for high risk, BCR2, or MET, respectively (all p < 0.05), with AUCs 0.64–0.72. GC stratified cumulative PCSM10 incidence from 2.8% to 30%. Combined use of case-control and cohort data is a potential limitation.Conclusions
In a large cohort with the longest follow-up to date, Decipher GC demonstrated clinically important prediction of PCSM at 10 yr, independent of CAPRA-S, in men with adverse pathologic features, BCR2, or MET after RP.Patient summary
Decipher genomic classifier may improve treatment decision-making for men with adverse or high risk pathology after radical prostatectomy. 相似文献16.
Pernelle Lavaud Gwenaëlle Gravis Stéphanie Foulon Florence Joly Stéphane Oudard Frank Priou Igor Latorzeff Loïc Mourey Michel Soulié Remy Delva Ivan Krakowski Brigitte Laguerre Christine Théodore Jean Marc Ferrero Philippe Beuzeboc Muriel Habibian Frédéric Rolland Gael Deplanque Karim Fizazi 《European urology》2018,73(5):696-703
Background
Androgen deprivation therapy (ADT) plus docetaxel is the standard of care in fit men with metastatic castration-naive prostate cancer (mCNPC) following results from GETUG-AFU 15, CHAARTED, and STAMPEDE. No data are available on the efficacy of treatments used for metastatic castration-resistant prostate cancer (mCRPC) in men treated upfront with ADT plus docetaxel for mCNPC.Objective
To investigate the efficacy and tolerance of subsequent treatments in patients treated upfront with chemo-hormonal therapy for mCNPC.Design, setting, and participants
Retrospective data from the GETUG-AFU 15 phase 3 trial were collected for treatments received for mCRPC.Outcome measurements and statistical analysis
For the first three lines of salvage treatment for mCRPC we investigated the biochemical progression-free survival, maximum prostate-specific antigen (PSA) decline, overall survival, and tolerance.Results and limitations
Overall, 245 patients received at least one treatment for mCRPC. For docetaxel used in first-line, a PSA decline ≥50% was observed in 25/66 (38%) and in 4/20 patients (20%) who had received upfront ADT alone and ADT plus docetaxel (p = 0.14). The median biochemical progression-free survival was 6.0 mo (95% confidence interval: 3.6–7.7) and 4.1 mo (95% confidence interval: 1.3–4.9), respectively. For docetaxel used in first- or second-line, a PSA decline ≥50% was observed in 36/80 (45%) and in 4/29 patients (14%) who had received upfront ADT alone and ADT plus docetaxel (p = 0.07). PSA declines ≥50% were observed with bicalutamide in 12/28 (43%) and 4/23 patients (17%) who had received upfront ADT alone and ADT plus docetaxel. Among men treated upfront with ADT plus docetaxel who received abiraterone or enzalutamide for mCRPC, 10/19 patients (53%) achieved a PSA decline ≥50%. Few grade 3–4 events occurred. Study limitations include the observational design and retrospective characteristics of this analysis, without standardized therapeutic salvage protocols, and the limited number of patients in some of the treatment subgroups.Conclusions
Docetaxel rechallenge following progression to mCRPC after upfront ADT plus docetaxel for mCNPC was active only in a limited number of patients. Available data on abiraterone and enzalutamide support maintained efficacy in this setting. The lack of standardized therapeutic protocols for men developing mCRPC limits the comparability between patients.Patient summary
Rechallenging docetaxel at castration-resistance was active only in a limited number of patients treated upfront with chemo-hormonal therapy for metastatic castration-naive prostate cancer. Anticancer activity was suggested with abiraterone or enzalutamide in this setting. 相似文献17.
Introduction
Prostate cancer is one of the commonest, malignancies affecting elderly males. Prostatic basal cell carcinoma, (PBCC) accounts for less than 0.01% of all prostate cancers.Observation
A 32-year-old man presented with hematuria and lower urinary tract symptoms. Clinical examination showed hard, nodular enlarged prostate with multiple penile hard nodules. His prostate-specific antigen (PSA) level was 0.91 ng/mL. Histopathological examination of the fingerguided prostate biopsy revealed a malignancy with features of basal cell carcinoma. Further imaging studies were performed and metastases were found in both lungs, penis, pelvic lymph nodes and right ischium.Conclusion
The current case highlights PBCC as a diagnostic pitfall which presented in a young adult with a normal PSA level. 相似文献18.
Giorgio Gandaglia Nicola Fossati R. Jeffrey Karnes Stephen A. Boorjian Michele Colicchia Alberto Bossi Thomas Seisen Cesare Cozzarini Nadia Di Muzio Barbara Noris Chiorda Emanuele Zaffuto Thomas Wiegel Shahrokh F. Shariat Gregor Goldner Steven Joniau Antonino Battaglia Karin Haustermans Gert De Meerleer Alberto Briganti 《European urology》2018,73(4):512-518
Background
Hormonal manipulation concomitant to salvage radiotherapy (SRT) given for biochemical recurrence (BCR) after radical prostatectomy (RP) improved outcomes in two randomized trials. However, neither of these studies focused on men treated at low prostate-specific antigen (PSA) levels.Objective
To test if the impact of androgen deprivation therapy (ADT) on metastasis in patients undergoing early SRT varies according to prostate cancer (PCa) features.Design, setting, and participants
A total of 525 patients received SRT at PSA levels ≤2 ng/ml.Outcome measurements and statistical analyses
Multivariable Cox regression analyses assessed factors associated with metastasis. We tested the hypothesis that the impact of ADT varied according to the risk of metastasis. An interaction with groups (concomitant ADT vs no ADT) and the probability of distant metastasis according to a newly developed model was tested. A nonparametric curve explored the relationship between the risk of metastasis and 10-yr metastasis rates according to ADT.Results and limitations
Median PSA and radiotherapy dose were 0.42 ng/ml and 66 Gy, respectively. Overall, 178 (34%) patients received ADT. At a median follow-up of 104 mo, 71 patients experienced metastasis. Grade group ≥4 (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.01–3.30), pT3b/4 (HR: 2.61; 95% CI: 1.51–4.52), and dose (HR: 0.82; 95% CI: 0.76–0.89) were associated with metastasis. The impact of ADT differed according to the risk of metastasis calculated using a multivariable model (p = 0.01). This was confirmed when considering patients treated with early SRT (p = 0.046), where ADT was associated with a reduction in the rate of metastasis only in eSRT; patients with more aggressive characteristics (ie, pT3b/4 and grade group ≥4, or pT3b/4 and PSA at eSRT ≥0.4 ng/ml).Conclusions
The beneficial effect of ADT concomitant to eSRT varied significantly according to disease characteristics, such that only men with more aggressive PCa features benefit from ADT in the eSRT setting for BCR after RP.Patient summary
The oncological benefits of concomitant androgen deprivation therapy (ADT) in patients undergoing salvage radiotherapy (SRT) vary according to pathological characteristics. Only patients with more aggressive disease characteristics seemed to benefit from the use of hormonal manipulation at the time of early SRT. Conversely, the potential side effects of ADT could be spared in patients with low prostate-specific antigen levels and favorable pathological features. 相似文献19.
J.A. Rodriguez-Rivera R. Rodriguez-Lay L. Zegarra-Montes F. Benzaghou B. Gaillac A.R. Azzouzi L.O. Reis P. Palma 《Actas urologicas espa?olas》2018,42(10):632-638
Objectives
To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP).Methods
Multicenter study in a scenario of prostate-specific antigen (PSA) ≤ 20 ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4 mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study.Results
In the intention-to-treat population (n = 81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%, 83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%, 88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported.Conclusions
Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa. 相似文献20.
Nicola Fossati R. Jeffrey Karnes Stephen A. Boorjian Marco Moschini Alessandro Morlacco Alberto Bossi Thomas Seisen Cesare Cozzarini Claudio Fiorino Barbara Noris Chiorda Giorgio Gandaglia Paolo Dell’Oglio Steven Joniau Lorenzo Tosco Shahrokh Shariat Gregor Goldner Wolfgang Hinkelbein Detlef Bartkowiak Alberto Briganti 《European urology》2017,71(6):886-893