Dr. Ron’s Research Review – May 17, 2017

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This week’s research review focuses on treatment of prostate cancer

 

A study published in the European Urology examined long-term (15-year) outcomes among non-curatively treated men according to prostate cancer risk category in a nationwide (Sweden), population-based study. Among men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. PCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men. (Rider et al., 2013)

A response urged that it’s time to change the treatment paradigm for prostate cancer. This observational study of 76 437 Swedish men with localized PCa again demonstrates that the majority of men with low- or intermediate-risk PCa will not die from their disease, even when curative interventions are withheld. The decision of whether localized PCa requires local treatment with curative intent should be based on its biologic aggressiveness (ie, Gleason pattern 4 or 5, perineural invasion, capsular perforation) and the tumor volume (ie, number of positive biopsies, size of tumor foci, T stage). In summary, the majority of men with contemporary, screen-detected PCa do not require immediate active treatment. (Studer and Albertsen, 2013)

 

Dr. Ron


 

Articles

Long-term outcomes among noncuratively treated men according to prostate cancer risk category in a nationwide, population-based study.
            (Rider et al., 2013) Download
BACKGROUND:  Limited data exist on long-term outcomes among men with prostate cancer (PCa) from population-based cohorts incorporating information on clinical risk category. OBJECTIVE:  To assess 15-yr mortality for men with PCa treated with noncurative intent according to clinical stage, Gleason score (GS), serum levels of prostate specific antigen (PSA), comorbidity, and age. DESIGN, SETTING, AND PARTICIPANTS:  Register-based cohort study of 76 437 cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed from 1991 through 2009 and treated with noncurative intent. Each case was placed in one of five risk categories: (1) low risk: T1-T2 tumor, PSA level <10 ng/ml, and GS ≤6; (2) intermediate risk: T1-T2 tumor and PSA level 10-<20 ng/ml or GS 7; (3) high risk: T3 tumor or PSA level 20-<50 ng/ml or GS ≥8; (4) regional metastases: N1 or T4 tumor or PSA level 50-100 ng/ml; and (5) distant metastases: M1 tumor or PSA ≥100 ng/ml. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:  Ten- and 15-yr cumulative risk of death after diagnosis from PCa, cardiovascular disease, and other causes. RESULTS AND LIMITATIONS:  Among men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. Limitations include potential misclassification in risk category due to GS assignment. CONCLUSIONS:  PCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men.

It's time to change the treatment paradigm for prostate cancer
            (Studer and Albertsen, 2013) Download
This observational study (Rider 2013) of 76 437 Swedish men with localized PCa again demonstrates that the majority of men with low- or intermediate-risk PCa will not die from their disease, even when curative interventions are withheld. The decision of whether localized PCa requires local treatment with curative intent should be based on its biologic aggressiveness (ie, Gleason pattern 4 or 5, perineural invasion, capsular perforation) and the tumor volume (ie, number of positive biopsies, size of tumor foci, T stage). In summary, the majority of men with contemporary, screen-detected PCa do not require immediate active treatment.

 

References

Rider, JR, et al. (2013), ‘Long-term outcomes among noncuratively treated men according to prostate cancer risk category in a nationwide, population-based study.’, Eur Urol, 63 (1), 88-96. PubMed: 22902040
Studer, UE and PC Albertsen (2013), ‘It’s time to change the treatment paradigm for prostate cancer’, Eur Urol, 63 (1), 97-9; discussion 99. PubMed: 22959353