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Alhadeethi A, Atia A, Alkhawaldeh IM, Ibrahim AA, Afifi E, Elwekel A, Nouh A, Morsi MH. Risk Factors for Cardiovascular-Specific Mortality in Patients With Prostate Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Study. Cureus 2023; 15:e51279. [PMID: 38288190 PMCID: PMC10823189 DOI: 10.7759/cureus.51279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Prostate cancer (PC) is responsible for large numbers of cancer-related deaths in males worldwide, and it has been linked to an increase in cardiovascular morbidity and mortality (CVM). The purpose of this research is to identify the incidence and risk factors for CVM in PC patients. METHODS In this retrospective cohort study, we collected data from patients with PC diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. CVM among PC patients was identified and compared to the general population using the standardized mortality ratio (SMR). The multivariable competing risk model with subdistribution hazard ratio (SHR) was used to analyze the data in a more complex method to discover the risk factors associated with CVM among PC patients. RESULTS Of the 171,147 identified PC patients, the median survival time was 117 months, with 17,168 dying from cardiovascular disease (CVD). Patients diagnosed at age 45-54 had a higher CVM risk than the age-standardized general population (SMR (95% CI): 19.01 (17.17-21.0)). Using multivariate competing risk regression analysis, aged 85 and older (SHR (95% CI): 20.9 (18.628-23.467)), black ethnicities (SHR (95% CI): 1.3 (1.264-1.398)), and patients without surgical intervention (SHR (95% CI): 1.35 (1.305-1.410)) had higher CVM. On the other hand, being of Asian/Pacific Islander or American Indian/Native Alaskan ethnicity (SHR (95% CI): 0.94 (0.891-0.993)), being diagnosed between 2007 and 2014 (SHR (95% CI): 0.63 (0.613-0.655)), and having an advanced disease stage and a lack of disease differentiation in the histology were found to be related with a lower CVM. CONCLUSION Patients with PC have a greater likelihood of dying from CVD. Several important risk factors for CVD have been discovered, including advanced age, black ethnicity, and patients without surgical intervention. These findings are limited by the retrospective nature of the analysis, relying solely on the SEER database, which imposes restrictions on accessing comprehensive patient data, including lifestyle factors and medical history.
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Affiliation(s)
- Abdulhameed Alhadeethi
- General Medicine, Al-Salam Teaching Hospital, Mosul, IRQ
- General Medicine, Medical Research Group of Egypt, Negida Academy LCC, Arlington, USA
| | - Ahmed Atia
- Oncology, Faculty of Medicine Kasr Al-Ainy, Cairo University, Cairo, EGY
| | | | - Ahmed A Ibrahim
- Cardiology, Faculty of Medicine, Menoufia University, Shibin El Kom, EGY
| | - Eslam Afifi
- Urology, Faculty of Medicine, Benha University, Benha, EGY
| | - Ahmed Elwekel
- Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Abdallah Nouh
- Oncology, Faculty of Medicine, Sohag University, Sohag, EGY
| | - Maha H Morsi
- Urology, Misr University for Science and Technology, 6th of October City, EGY
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Braga-Basaria M, Travison TG, Taplin ME, Lin A, Dufour AB, Habtemariam D, Nguyen PL, Kibel AS, Ravi P, Bearup R, Kackley H, Kafel H, Reid K, Storer T, Simonson DC, McDonnell M, Basaria S. Gaining metabolic insight in older men undergoing androgen deprivation therapy for prostate cancer (the ADT & Metabolism Study): Protocol of a longitudinal, observational, cohort study. PLoS One 2023; 18:e0281508. [PMID: 36763576 PMCID: PMC9916640 DOI: 10.1371/journal.pone.0281508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Androgen deprivation therapy (ADT), a cornerstone of treatment for patients with locally advanced and metastatic prostate cancer, is associated with many adverse effects, including osteoporosis, sexual dysfunction, fatigue, and vasomotor symptoms. It is also associated with loss of muscle mass and increased adiposity. This change in body composition is likely the inciting event in the development of insulin resistance, an independent risk factor for diabetes mellitus and cardiovascular disease. Although the occurrence of insulin resistance during ADT has been reported, it remains unclear whether this insulin resistance is primarily hepatic or muscular. Similarly, the mechanisms that lead to insulin resistance also remain unknown. The ADT & Metabolism Study was designed to address these knowledge gaps, as the elucidation of the predominant site of insulin resistance will allow prevention strategies and the use of targeted, tissue-specific insulin-sensitizing agents in patients undergoing ADT. This prospective, mechanistic, single-center, 24-week, observational cohort study will enroll treatment-naïve adult men with prostate cancer about to undergo surgical or medical ADT for at least 24 weeks (ADT group; n = 50) and a control group of men who had undergone radical prostatectomy and are in remission (non-ADT group, n = 25). The primary outcome is to determine the site of insulin resistance (skeletal muscle or liver) using frequent sampling oral glucose tolerance test at baseline and 12 and 24 weeks after commencement of ADT (ADT group) or after enrollment in the study (non-ADT group). Secondary outcomes will assess changes in hepatic and intramyocellular fat (using magnetic resonance spectroscopy), inflammatory markers, adipokines, free fatty acids, and changes in body composition (assessed using dual-energy x-ray absorptiometry) and their correlation with the development of insulin resistance. Exploratory outcomes will include changes in muscle performance, physical function, physical activity, vitality, and sexual drive.
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Affiliation(s)
- Milena Braga-Basaria
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas G Travison
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alexander Lin
- Department of Radiology, Center for Clinical Spectroscopy, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alyssa B Dufour
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel Habtemariam
- Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adam S Kibel
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Praful Ravi
- Lank Center for Genitourinary Oncology and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richelle Bearup
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hannah Kackley
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hussein Kafel
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kieran Reid
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas Storer
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Donald C Simonson
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marie McDonnell
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shehzad Basaria
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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3
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Khoshkar Y, Vigneswaran HT, Eloranta S, Andersson TML, Schain F, Boman A, Dahlkild M, Liwing J, Leval A, Akre O, Aly M. Cardiovascular, bone, and metabolic health in men with castrate-resistant prostate cancer treated with androgen deprivation: a matched cohort study. Acta Oncol 2022; 61:1377-1385. [DOI: 10.1080/0284186x.2022.2141077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Yashar Khoshkar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hari T. Vigneswaran
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Therese M.-L. Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Janssen Global Services, Solna, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
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Innos K, Paapsi K, Alas I, Baum P, Kivi M, Kovtun M, Okas R, Pokker H, Rajevskaja O, Rautio A, Saretok M, Valk E, Žarkovski M, Denissov G, Lang K. Evidence of overestimating prostate cancer mortality in Estonia: a population-based study. Scand J Urol 2022; 56:359-364. [PMID: 36073064 DOI: 10.1080/21681805.2022.2119274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prostate cancer (PC) mortality statistics in Estonia has shown inconsistencies with incidence and survival trends. The aim of this population-based study was to assess the accuracy of reporting PC as the underlying cause of death and estimate the effect of misattribution in assigning cause of death on PC mortality rates. MATERIAL AND METHODS The Estonian Causes of Death Registry (CoDR) and Cancer Registry provided data on all men in Estonia who died in 2017 and had a mention of PC on any field of the death certificate or had a lifetime diagnosis of PC. A blinded review of medical records was conducted by an expert panel to ascertain whether the underlying cause was PC or other death. We estimated the agreement between the underlying causes of death registered at the CoDR and those ascertained by medical review and calculated corrected mortality rates. RESULTS The study population included 655 deaths. Among 277 PC deaths registered at CoDR, 164 (59%) were verified by medical review. Among 378 other deaths registered at CoDR, 17 (5%) were ascertained as PC deaths by medical review. In total, the number of PC deaths decreased from 277 to 181 and the corrected age standardized (world) mortality rate decreased from 20 to 13 per 100 000 (1.5-fold overestimation, 95% confidence interval 1.2-1.9). CONCLUSIONS PC mortality statistics in Estonia should be interpreted with caution and possible overestimation considered when making policy decisions. Quality assurance mechanisms should be reinforced in the whole death certification process.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Indrek Alas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Peep Baum
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Martin Kivi
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Mihhail Kovtun
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rauno Okas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Helis Pokker
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Olga Rajevskaja
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Mikk Saretok
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Elari Valk
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Gleb Denissov
- Causes of Death Registry, National Institute for Health Development, Tallinn, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Detterbeck FC, Blasberg JD, Woodard GA, Decker RH, Kumbasar U, Park HS, Mase VJ, Bade BC, Li AX, Brandt WS, Madoff DC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 1: a guide to decision-making. J Thorac Dis 2022; 14:2340-2356. [PMID: 35813719 PMCID: PMC9264102 DOI: 10.21037/jtd-21-1823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/21/2022] [Indexed: 12/02/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, Stereotactic Body Radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods Based on a systematic review from 2000-2021, evidence regarding relevant outcomes was assembled, with attention to aspects of applicability, uncertainty and effect modifiers. A framework was developed to present this information a format that enhances decision-making at the point of care for individual patients. Results While patients often cross over several boundaries, the evidence fits into categories of healthy patients, compromised patients, and favorable tumors. In healthy patients with typical (i.e., solid spiculated) lung cancers, the impact on long-term outcomes is the major driver of treatment selection. This is only slightly ameliorated in older patients. In compromised patients increasing frailty accentuates short-term differences and diminishes long-term differences especially when considering non-surgical vs. surgical approaches; nuances of patient selection (technical treatment feasibility, anticipated risk of acute toxicity, delayed toxicity, and long-term outcomes) as well as patient values are increasingly influential. Favorable (less-aggressive) tumors generally have good long-term outcomes regardless of the treatment approach. Discussion A framework is provided that organizes the evidence and identifies the major drivers of decision-making for an individual patient. This facilitates blending available evidence and clinical judgment in a flexible, nuanced manner that enhances individualized clinical care.
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Affiliation(s)
| | - Justin D. Blasberg
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Henry S. Park
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Cardiothoracic Surgery, Washington University School of Medicine, St louis, MO, USA
| | - David C. Madoff
- Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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6
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Elmehrath AO, Afifi AM, Al-Husseini MJ, Saad AM, Wilson N, Shohdy KS, Pilie P, Sonbol MB, Alhalabi O. Causes of Death Among Patients With Metastatic Prostate Cancer in the US From 2000 to 2016. JAMA Netw Open 2021; 4:e2119568. [PMID: 34351403 PMCID: PMC8343467 DOI: 10.1001/jamanetworkopen.2021.19568] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Owing to improved survival among US patients with prostate cancer (PC), patients tend to live long enough after a PC diagnosis for non-cancer-related comorbidities to be associated with their overall survival. Although studies have investigated causes of death among patients with localized PC, data are lacking regarding causes of death among patients with metastatic PC. OBJECTIVE To assess causes of death among US patients with metastatic PC from 2000 to 2016. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program database to analyze a sample of 26 168 US men who received a diagnosis of metastatic PC from January 1, 2000, to December 31, 2016. Data were analyzed from February 2 to July 28, 2020. EXPOSURE Diagnosis of metastatic PC. MAIN OUTCOMES AND MEASURES Standardized mortality ratios (SMRs) for different causes of death were calculated by dividing the observed number of deaths from each cause of death by the expected number of deaths in the age-matched US male population for the same period, adjusting for age and race/ethnicity. RESULTS Of 26 168 patients with metastatic PC included in the analysis, 48.9% were aged 50 to 70 years (mean age at diagnosis, 70.83 years); 74.5% were White individuals, and 72.7% received a diagnosis of stage M1b metastatic PC. A total of 16 732 patients (63.9%) died during the follow-up period. The mean age at death was 74.13 years. Most deaths (59.0%) occurred within the latency period of 2 years after diagnosis of metastatic PC, whereas 31.6% occurred 2 to 5 years after diagnosis and 9.4% occurred more than 5 years after diagnosis. Of the total deaths, 13 011 (77.8%) were from PC, 924 (5.5%) were from other cancers, and 2797 (16.7%) were from noncancer causes. During all latency periods, the most common noncancer causes of death were cardiovascular diseases (SMR, 1.34; 95% CI, 1.26-1.42), chronic obstructive pulmonary disease (SMR, 1.19; 95% CI, 1.03-1.36), and cerebrovascular diseases (SMR, 1.31; 95% CI, 1.13-1.50). CONCLUSIONS AND RELEVANCE In this cohort study, deaths from noncancer causes, including cardiovascular disease, constituted a substantial number of deaths among men with metastatic PC. Therapy and follow-up should be tailored to the needs of each patient with metastatic PC, and counseling regarding future health risks should be provided.
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Affiliation(s)
| | - Ahmed M. Afifi
- University of Kentucky College of Medicine, Lexington
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Anas M. Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nathaniel Wilson
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Kyrillus S. Shohdy
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Patrick Pilie
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohamad Bassam Sonbol
- Mayo Clinic Cancer Center, Division of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Omar Alhalabi
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chow AK, Vourganti S, Konety BR. Re: Oral Relugolix for Androgen-deprivation Therapy in Advanced Prostate Cancer. Eur Urol 2021; 80:386. [PMID: 34092438 DOI: 10.1016/j.eururo.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander K Chow
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
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8
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Cone EB, Reese S, Marchese M, Nabi J, McKay RR, Kilbridge KL, Trinh QD. Cardiovascular toxicities associated with abiraterone compared to enzalutamide-A pharmacovigilance study. EClinicalMedicine 2021; 36:100887. [PMID: 34308305 PMCID: PMC8257986 DOI: 10.1016/j.eclinm.2021.100887] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is standard-of-care for advanced prostate cancer. Studies have generally found increased cardiovascular risks associated with ADT, but the comparative risk of newer agents is under-characterized. We defined the cardiac risks of abiraterone and enzalutamide, using gonadotropic releasing hormone (GnRH) agonists to establish baseline ADT risk. METHODS We used VigiBase, the World Health Organization pharmacovigilance database, to identify cardiac adverse drug reactions (ADRs) in a cohort taking GnRH agonists, abiraterone, or enzalutamide therapy for prostate cancer, comparing them to all other patients. To examine the relationship, we used an empirical Bayes estimator to screen for significance, then calculated the reporting odds ratio (ROR), a surrogate measure of association. A lower bound of a 95% confidence interval (CI) of ROR > 1 reflects a disproportionality signal that more ADRs are observed than expected due to chance. FINDINGS We identified 2,433 cardiac ADRs, with higher odds for abiraterone compared to all other VigiBase drugs for overall cardiac events (ROR 1•59, 95% CI 1•48-1•71), myocardial infarction (1•35, 1•16-1•58), arrythmia (2•04, 1•82-2•30), and heart failure (3•02, 2•60-3•51), but found no signal for enzalutamide. Patients on GnRH agonists also had increased risk of cardiac events (ROR 1•21, 95% CI 1•12-1•30), myocardial infarction (1•80, 1•61-2•03) and heart failure (2•06, 1•76-2•41). INTERPRETATION We found higher reported odds of cardiac events for abiraterone but not enzalutamide. Our data may suggest that patients with significant cardiac comorbidities may be better-suited for therapy with enzalutamide over abiraterone. FUNDING None.
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Affiliation(s)
- Eugene B. Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Corresponding author.
| | - Stephen Reese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Junaid Nabi
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rana R. McKay
- Division of Hematology/Oncology, University of California, San Diego, CA, United States
| | - Kerry L. Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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9
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Weiner AB, Li EV, Desai AS, Press DJ, Schaeffer EM. Cause of death during prostate cancer survivorship: A contemporary, US population-based analysis. Cancer 2021; 127:2895-2904. [PMID: 33882145 DOI: 10.1002/cncr.33584] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 01/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND More than 3.6 million men in the United States harbor a diagnosis of prostate cancer (PCa). The authors sought to provide in-depth analyses of the causes of death for contemporary survivors. METHODS The authors performed a population-based cohort study in the United States (2000-2016) to assess causes of death for men diagnosed with PCa stratified by demographics and tumor stage. Using general population data, they calculated standardized mortality ratios (SMRs) as observed-to-expected death ratios. RESULTS In total, 752,092 men with PCa, including 200,302 who died (27%), were assessed. A total of 29,048 men with local/regional disease (17%) died of PCa, whereas more than 4-fold men died of other causes (n = 143,719 [83%]). SMRs for death from noncancer causes (0.77; 95% confidence interval [CI], 0.77-0.78) suggested that these men were less likely than the general population to die of most other causes. The most common noncancer cause of death was cardiac-related (23%; SMR, 0.76; 95% CI, 0.75-0.77). Among men with distant PCa, 90% of deaths occurred within 5 years of diagnosis. Although deaths due to PCa composed the majority of deaths (74%), SMRs suggested that men with distant PCa were at heightened risk for death from most other noncancer causes (1.50; 95% CI, 1.46-1.54) and, in particular, for cardiac-related death (SMR, 1.48; 95% CI, 1.41-1.54) and suicide (SMR, 2.32; 95% CI, 1.78-2.96). Further analyses demonstrated that causes of death varied by patient demographics. CONCLUSIONS Causes of death during PCa survivorship vary by patient and tumor characteristics. These data provide valuable information regarding health care prioritization during PCa survivorship. LAY SUMMARY Men with early-stage prostate cancer are 4-fold more likely to die of other causes, whereas those with advanced prostate cancer are at increased risk for several causes not related to prostate cancer in comparison with the general population. These findings can help guide physicians taking care of men with a diagnosis of prostate cancer.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric V Li
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuj S Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J Press
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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10
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Park J, Han K, Shin DW, Park SH, Shin HB. Conditional Relative Survival and Competing Mortality of Patients with Prostate Cancer in Korea: A Nationwide Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:326-334. [PMID: 33187966 DOI: 10.1158/1055-9965.epi-20-1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/16/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Conditional relative survival (CRS) and competing mortality are important survivorship issues after cancer treatment. We aimed to investigate them among patients with prostate cancer treated by various modalities. METHODS Using a nationwide population-based database, we calculated 5-year CRS conditioned on 1 through 5 years survival after diagnosis. These rates were stratified by age, sex, socioeconomic status, comorbidities, and treatment received. Cause of death and estimated cause-specific mortality were also described and considered with competing risks. RESULTS A total of 81,773 patients newly diagnosed with primary prostate cancer from 2007 to 2013 were identified. The 5-year CRS was 81.1% at baseline, but increased gradually up to 95.4% at 4 years and exceeded 100% at 5 years after diagnosis, suggesting no excess mortality compared with the general population. However, this pattern differed by treatment received. Patients who underwent androgen deprivation therapy showed 5-year CRS of only 88.4% at 5 years after diagnosis, implying persistent excess mortality. Prostate cancer constituted around one-third of deaths, while other cancers were the main cause of death within <2 years after diagnosis. Noncancer-related deaths, including cardiovascular disease and respiratory disease, increased with time since diagnosis. CONCLUSIONS CRS rates for patients with prostate cancer improved over time and exceeded that of the general population at 5 years. Other cancers were the main cause of death in the earlier survivorship phase, and deaths from noncancer causes gradually increased over time. IMPACT Our findings will help patients and clinicians make evidence-based decisions on the basis of a patient's dynamic risk profile.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (South)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (South)
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (South). .,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea (South).,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea (South)
| | - Sang Hyun Park
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea (South)
| | - Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (South)
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11
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Duivenvoorden WCM, Naeim M, Hopmans SN, Yousef S, Werstuck GH, Dason S, Pinthus JH. Protective effect of pharmacological castration on metabolic perturbations and cardiovascular disease in the hyperglycemic male ApoE -/-:Ins2 +/Akita mouse model. Prostate Cancer Prostatic Dis 2020; 24:389-397. [PMID: 32989260 DOI: 10.1038/s41391-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Unlike in other mouse models of atherogenesis, it has recently been suggested that orchiectomy plays a role in accelerating atherosclerosis and inhibiting the progression of cardiovascular disease in the ApoE-/-:Ins2+/Akita mouse model of hyperglycemia. Androgen-deprivation therapy (ADT) is a common treatment for prostate cancer, a population with high prevalence of cardiovascular disease and its risk factors. Our objectives were to test and further characterize the effects of pharmacological castration which is currently the acceptable modality to deliver ADT in the clinic. METHODS Male ApoE-/-:Ins2+/Akita mice received one of three modes of ADT (gonadotropin-releasing hormone (GnRH)-antagonist (degarelix), GnRH-agonist (leuprolide), or bilateral orchiectomy) and were compared to corresponding untreated control mice (n = 9-13/group). Mice were followed for 5 months. Body weight, fasting blood glucose, glucose tolerance, serum C-peptide, leptin, and testosterone levels along with atherosclerotic aortic plaque size and characteristics were determined. In a separate experiment, the survival of mice, untreated and on ADT, was determined. RESULTS Castration was achieved for all three modes of ADT. However, degarelix-treated mice gained significantly less weight, had lower serum leptin levels and systolic blood pressure compared to orchiectomy and leuprolide-treated mice. ADT improved dysglycemia and atherosclerotic burden. GnRH-antagonist significantly improved survival compared to GnRH-agonist but not compared to orchiectomy. CONCLUSIONS Further characterization of the ApoE-/-:Ins2+/Akita mouse model confirms that pharmacological ADT ameliorated metabolic syndrome and cardiovascular complications. Improved dysglycemia and atherosclerosis associated with increased survival which was longest after degarelix followed by orchiectomy.
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Affiliation(s)
- Wilhelmina C M Duivenvoorden
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Magda Naeim
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sarah N Hopmans
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sadiya Yousef
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Geoff H Werstuck
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Shawn Dason
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada. .,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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12
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Minimizing Risk to Maximize Outcomes. Eur Urol 2020; 79:54-55. [PMID: 32855009 DOI: 10.1016/j.eururo.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022]
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13
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Pak S, You D, Jeong IG, Lee DE, Kim SH, Joung JY, Lee KH, Hong JH, Kim CS, Ahn H. Cause of Mortality after Radical Prostatectomy and the Impact of Comorbidity in Men with Prostate Cancer: A Multi-institutional Study in Korea. Cancer Res Treat 2020; 52:1242-1250. [PMID: 32632083 PMCID: PMC7577814 DOI: 10.4143/crt.2020.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to examine the causes of death in Korean patients who underwent radical prostatectomy for prostate cancer and investigate the relationship between comorbidity and mortality. Materials and Methods We conducted a retrospective multicenter cohort study including 4,064 consecutive patients who had prostate cancer and underwent radical prostatectomy between January 1998 and June 2013. The primary endpoint of this study was all-cause mortality, and the secondary endpoints were cancer-specific mortality (CSM) and other-cause mortality (OCM). Charlson comorbidity index (CCI) was calculated to assess the comorbidities of each patient. Results Of 4,064 patients, 446 (11.0%) died during follow-up. The cause of death was prostate cancer in 132 patients (29.6%), other cancers in 121 patients (27.1%), and vascular disease in 57 patients (12.8%) in our cohort. The overall 10-year CSM rate was lower than the OCM rate (4.6% vs. 10.5%). The 10-year CSM rate was lower than the OCM rate in low- to intermediate-risk group patients (1.2% vs. 10.6%), whereas they were similar in high-risk group patients (11.8% vs. 10.1%). In the multivariable analysis, CCI was independently associated with all-cause mortality after radical prostatectomy, regardless of age and pathologic features. Conclusion Death from prostate cancer was rare in Korean men who underwent radical prostatectomy. Clinicians should be aware of the possibility of overtreatment of low-risk prostate cancer in men with significant comorbidity. Our findings may help to facilitate counseling and plan management in this patient group.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Core Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Kang-Hyun Lee
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Cone EB, Marchese M, Reese SW, Sun M, Nabi J, Kilbridge K, Trinh QD. Lower odds of cardiac events for gonadotrophin-releasing hormone antagonists versus agonists. BJU Int 2020; 126:9-10. [PMID: 32232935 DOI: 10.1111/bju.15059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eugene B Cone
- Division of Urological Surgery and Center fo Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maya Marchese
- Division of Urological Surgery and Center fo Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen W Reese
- Division of Urological Surgery and Center fo Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Junaid Nabi
- Division of Urological Surgery and Center fo Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kerry Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center fo Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Moghanaki D, Howard LE, De Hoedt A, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Terris MK, Freedland SJ. Validity of the National Death Index to ascertain the date and cause of death in men having undergone prostatectomy for prostate cancer. Prostate Cancer Prostatic Dis 2019; 22:633-635. [PMID: 31036926 PMCID: PMC6819236 DOI: 10.1038/s41391-019-0146-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 11/29/2022]
Abstract
Background The National Death Index (NDI) is a centralized database containing information from death certificates that is frequently referenced by health and medical investigators to ascertain vital statistics. Yet, it commonly includes misclassified causes of death. Since the NDI is frequently relied upon in studies that evaluate outcomes following radical prostatectomy (RP) for prostate cancer (PC), we evaluated its validity by referencing mortality data from the Shared Equal Access Regional Cancer Hospital (SEARCH) database which is a prospectively managed database of 5,009 Veterans who underwent a RP at eight Veterans Affairs medical centers between 1982 and 2016. Methods We compared vital status, cause of death and date of death from the SEARCH database with the NDI. Results A total of 1,312 men in SEARCH were deceased, yet the NDI reported 17% (219) of those men as still alive. Among the 1,093 men who had concordant vital status in both SEARCH and NDI, the date of death was an exact match within one day, a week, or 31 days in 94%, 97%, 99%, and 100%, respectively. Of those men coded as dying from prostate cancer in the SEARCH database (n=105), 12% were coded as having died from non-PC causes in the NDI. Meanwhile, among patients coded by the NDI as having died of PC (n=139), 34% were coded in SEARCH as having died of non-PC causes. Conclusions These findings demonstrate that the NDI provides accurate dates of death, but frequently misclassifies whether a death was due to prostate cancer. Studies that rely upon death certificates, as capture in the NDI, may be unreliable to report prostate cancer specific mortality rates after prostatectomy.
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Affiliation(s)
- Drew Moghanaki
- Atlanta Veterans Affairs Health Care System, Atlanta, GA, USA.
| | - Lauren E Howard
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | | | | | | | | | - Stephen J Freedland
- Durham Veterans Affairs Medical Center, Durham, NC, USA.,Cedars-Sinai Medical Center, Los Angeles, CA, USA
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16
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Di Francesco S, Robuffo I, Caruso M, Giambuzzi G, Ferri D, Militello A, Toniato E. Metabolic Alterations, Aggressive Hormone-Naïve Prostate Cancer and Cardiovascular Disease: A Complex Relationship. ACTA ACUST UNITED AC 2019; 55:medicina55030062. [PMID: 30866568 PMCID: PMC6473682 DOI: 10.3390/medicina55030062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
Background: Epidemiological studies suggest a possible relationship between metabolic alterations, cardiovascular disease and aggressive prostate cancer, however, no clear consensus has been reached. Objective: The aim of the study was to analyze the recent literature and summarize our experience on the association between metabolic disorders, aggressive hormone-naïve prostate cancer and cardiovascular disease. Method: We identified relevant papers by searching in electronic databases such as Scopus, Life Science Journals, and Index Medicus/Medline. Moreover, we showed our experience on the reciprocal relationship between metabolic alterations and aggressive prostate cancer, without the influence of hormone therapy, as well the role of coronary and carotid vasculopathy in advanced prostate carcinoma. Results: Prostate cancer cells have an altered metabolic homeostatic control linked to an increased aggressivity and cancer mortality. The absence of discrimination of risk factors as obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia and inaccurate selection of vascular diseases as coronary and carotid damage at initial diagnosis of prostate cancer could explain the opposite results in the literature. Systemic inflammation and oxidative stress associated with metabolic alterations and cardiovascular disease can also contribute to prostate cancer progression and increased tumor aggressivity. Conclusions: Metabolic alterations and cardiovascular disease influence aggressive and metastatic prostate cancer. Therefore, a careful evaluation of obesity, diabetes mellitus, dyslipidemia, systemic arterial hypertension, together with a careful evaluation of cardiovascular status, in particular coronary and carotid vascular disease, should be carried out after an initial diagnosis of prostatic carcinoma.
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Affiliation(s)
- Simona Di Francesco
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
- Department of Urological, Biomedical and Translational Sciences, Federiciana University, 87100 Cosenza, Italy.
| | - Iole Robuffo
- Institute of Molecular Genetics, National Research Council, Section of Chieti, 66100 Chieti, Italy.
| | - Marika Caruso
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
- Department of Urological, Biomedical and Translational Sciences, Federiciana University, 87100 Cosenza, Italy.
| | - Giulia Giambuzzi
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Deborah Ferri
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Andrea Militello
- Department of Urological, Biomedical and Translational Sciences, Federiciana University, 87100 Cosenza, Italy.
- Urology and Andrology Section, Villa Immacolata Hospital, 01100 Viterbo, Italy.
| | - Elena Toniato
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
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17
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Yanase T, Kawanami T, Tanaka T, Tanabe M, Nomiyama T. Impact of metabolic disorders on prostate cancer growth: Androgen and insulin resistance perspectives. Reprod Med Biol 2017; 16:252-257. [PMID: 29259475 PMCID: PMC5715889 DOI: 10.1002/rmb2.12039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/06/2017] [Indexed: 12/24/2022] Open
Abstract
Background A high prevalence of cancers in metabolic disorders, like metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM), recently has been noted, including prostate cancer (PC), which is androgen-sensitive. However, the pathological relationship among testosterone and insulin and insulin-like growth factor (IGF)-1 signaling in relation to MetS and T2DM with PC remains unclear. Methods Papers were reviewed, including those by the authors. Results In MetS or the initial stage of T2DM accompanying insulin resistance, insulin and IGF-1 signaling could be essential for PC growth. In the advanced stage of T2DM, the decrease in insulin secretion might work against PC growth. A decrease in testosterone concentration with T2DM also might suppress PC proliferation. Androgen deprivation therapy in patients with PC might increase the risk of MetS and/or T2DM and consequently cardiovascular events. Certain drugs for T2DM treatment, such as metformin and glucagon-like peptide-1 analog, potentially might be useful for the treatment of PC. Conclusion The improvement of insulin resistance appears to be essential for the prevention of PC growth. Further studies are needed to clarify the complicated pathophysiology of metabolic disorders in PC growth.
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Affiliation(s)
- Tashihiko Yanase
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
| | - Takako Kawanami
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Tomoko Tanaka
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Takashi Nomiyama
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
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18
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Cardiovascular Complications of Androgen Deprivation Therapy for Prostate Cancer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:61. [PMID: 28653290 DOI: 10.1007/s11936-017-0563-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Prostate cancer is a common hormone-sensitive malignancy, and androgen deprivation therapy (ADT) is a cornerstone of therapy in advanced disease. The most important and controversial of ADT side effects is cardiovascular (CV) toxicity. Prospective trials have demonstrated that ADT increases CV risk by lowering insulin sensitivity, causing dyslipidemia, and causing weight gain thus mimicking metabolic syndrome. Retrospective data suggests that ADT increases CV risk; however, data on cardiovascular mortality is equivocal. This discrepancy can be explained by study design limitations and selection bias inherent to post hoc analysis of trials not designed to study CV outcomes. Despite the adverse CV and metabolic sequelae of ADT, little data is available for optimal cardiac screening or management in these patients. The short-term CV risk is higher in patients who have had CV events in the year prior to starting ADT. A careful discussion of risk and benefit of ADT must take place with patients with pre-existing CV disease prior to initiating hormonal therapy. The duration of ADT must be considered. We recommend diligent pretherapy screening and optimization of cardiac risk factors and close surveillance especially within the first year of ADT.
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19
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Park J, Suh B, Shin DW, Hong JH, Ahn H. Cause of Death in Korean Men with Prostate Cancer: an Analysis of Time Trends in a Nationwide Cohort. J Korean Med Sci 2016; 31:1802-1807. [PMID: 27709860 PMCID: PMC5056214 DOI: 10.3346/jkms.2016.31.11.1802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/11/2016] [Indexed: 01/17/2023] Open
Abstract
Despite rapid increase in incidence of prostate cancer (PC) and PC survivors, there are few studies regarding competing causes of death and time trends in Asian population. We conducted a cohort study of 2% nationwide random sample of Korean National Health Insurance employees. A total of 873 patients who had received active treatments, including surgery, radiation therapy (RT) and androgen deprivation therapy (ADT), for newly diagnosed PC between 2003 and 2010 were included. The cause of death was categorized as PC, other cancers, cardiovascular disease, and other causes. During a median follow-up of 4.75 years, 29.4% (257/873) of the study population died. PC, other cancers, cardiovascular disease, and other causes were responsible for 46.3%, 35.4%, 6.6%, and 11.7%, respectively, of the decedents. Significant differences existed in the cause of death among treatment groups (P < 0.001). Only 20% and 9.5% of surgery and RT group died of PC, whereas 63.9% of ADT group died of PC. Other cancers were responsible for 56%, 74.6% and 17.8% of death in the surgery, RT and ADT group, respectively, while cardiovascular disease accounted for 4%, 6.3%, and 7.1% of death in the treatment groups. Analysis of time trends showed that PC-specific death tended to decrease (from 42.9% in 2003 to 23.1% in 2010), whereas non-PC causes tended to increase over the 8 years. Our results are valuable in overviewing causes of death and time trends in Korean PC patients, and planning future health policy for PC.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Beomseok Suh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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20
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Ahmad AS, Vasiljević N, Carter P, Berney DM, Møller H, Foster CS, Cuzick J, Lorincz AT. A novel DNA methylation score accurately predicts death from prostate cancer in men with low to intermediate clinical risk factors. Oncotarget 2016; 7:71833-71840. [PMID: 27708246 PMCID: PMC5342126 DOI: 10.18632/oncotarget.12377] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/20/2016] [Indexed: 01/01/2023] Open
Abstract
Clinically aggressive disease behavior is difficult to predict in men with low to intermediate clinical risk prostate cancer and methylation biomarkers may be a valuable adjunct for assessing the management of these patients. We set to evaluate the utility of DNA methylation to identify high risk disease in men currently considered as low or intermediate risk. DNA was extracted from formalin-fixed paraffin-embedded transurethral prostate resection tissues collected during the years 1990-96 in a watchful-waiting cohort of men in the UK. The primary end point was death of prostate cancer, assessed by reviewing cancer registry records from 2009. Methylation was quantified by pyrosequencing assays for six genes (HSPB1, CCND2, TIG1, DPYS, PITX2, and MAL) with established biomarker value in prostate cancer. A novel prognostic methylation score was developed by multivariate Cox modelling using the six methylation biomarkers in 385 men with low-and-intermediate clinical risk variables and its prognostic value compared to two previously defined clinically-derived risk scores. Methylation score was the most significant variable in univariate and bivariate analysis in men with low-to-intermediate CAPRA risk score. When combined with CAPRA score the hazard ratio was 2.02; 95% confidence interval, 1.40-2.92. For a methylation score sensitivity of 83% the specificity was 44%, while the maximum achieved sensitivity by CAPRA was 68% at a specificity of 44%. The derived methylation score is a strong predictor of aggressive prostate cancer that could have an important role in directing the management of patients with low-to-intermediate risk disease. The estimated areas under the curve (AUC) at 10 years of follow-up were 0.62 (95% CI: 0.51, 0.70) and 0.74 (95% CI: 0.65, 0.82) for CAPRA, and combined (CAPRA + methylation) risk score (CRS) respectively.
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Affiliation(s)
- Amar S. Ahmad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Nataša Vasiljević
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Paul Carter
- Centre for Molecular Pathology, Royal Marsden Hospital, Sutton, SM2 5PT, UK
| | - Daniel M Berney
- Molecular Oncology Centre, Barts Cancer Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Henrik Møller
- King's College London, Cancer Epidemiology and Population Global Health Program, London, SE1 3QD, UK
| | | | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
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21
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New drugs in the treatment of elderly patients with metastatic castration-resistance prostate cancer. TUMORI JOURNAL 2016; 102:361-6. [PMID: 27151879 DOI: 10.5301/tj.5000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/20/2022]
Abstract
Treatment of prostate cancer is continually evolving and new therapies have become available. However, the management of elderly patients is challenging due to their age and comorbidities. Androgen deprivation therapy remains the mainstay treatment of hormonal-sensitive disease. Nevertheless, when disease becomes resistant to castration, docetaxel-based chemotherapy represents the standard rescue therapy irrespective of patient age. Recently, chemotherapeutic agents such as cabazitaxel and hormonal therapies such as abiraterone acetate and enzalutamide have been shown to improve survival in patients with progression of disease before or following docetaxel. This review focuses on the safety and efficacy results of these new drugs in elderly patients.
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22
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The role of gonadotrophin-releasing hormone antagonists in the treatment of patients with advanced hormone-dependent prostate cancer in the UK. World J Urol 2016; 34:1601-1609. [PMID: 27097892 PMCID: PMC5114327 DOI: 10.1007/s00345-016-1818-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/13/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Comparing gonadotrophin-releasing hormone (GnRH) antagonists and agonists as androgen deprivation therapy for advanced prostate cancer (PC). Methods This article stems from a round-table meeting in December 2014 to compare the properties of GnRH agonists and antagonists in the published literature in order to identify the patient groups most likely to benefit from GnRH antagonist therapy. A broad PubMed and congress abstract search was carried out in preparation for the meeting to ensure that the latest data and opinion were available for the discussions. Results In randomised, controlled trials, GnRH antagonist therapy provides more rapid suppression of luteinising hormone, follicle-stimulating hormone and testosterone than GnRH agonist treatment. Compared with the GnRH agonist, there is evidence of improved disease control by a GnRH antagonist, with longer interval to prostate-specific antigen progression and greater reduction of serum alkaline phosphatase. In a post hoc analysis of six randomised trials, the risk of cardiac events within 1 year of initiating therapy was significantly lower among men receiving GnRH antagonist than agonist. Pre-clinical laboratory data suggest a number of mechanisms whereby GnRH antagonist therapy may benefit men with pre-existing cardiovascular disease (CVD), the most plausible hypothesis being that, unlike GnRH agonists, GnRH antagonists do not activate T lymphocytes, which act to increase atherosclerotic plaque rupture. Conclusion When making treatment decisions, clinicians should consider comorbidities, particularly CVD, in addition to effects on PC. GnRH antagonists may be appropriate in patients with significant CV risk, existing osteopenia, lower urinary tract symptoms and significant metastatic disease.
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Poulsen CB, Mortensen MB, Koechling W, Sørensen CB, Bentzon JF. Differences in Hypercholesterolemia and Atherogenesis Induced by Common Androgen Deprivation Therapies in Male Mice. J Am Heart Assoc 2016; 5:e002800. [PMID: 26908406 PMCID: PMC4802473 DOI: 10.1161/jaha.115.002800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of prostate cancer often involves androgen deprivation therapy (ADT) by gonadotropin-releasing hormone (GnRH) receptor agonists, GnRH receptor antagonists, or orchiectomy. ADT may increase the rate of cardiovascular disease events, but recent clinical studies suggested that not all means of ADT carry the same risk, raising the possibility of non-testosterone-mediated effects of different forms of ADT on atherosclerosis. Here we compared effects of ADT on atherosclerosis in intact and orchiectomized Apoe-deficient mice. METHODS AND RESULTS Chow-fed Apoe-deficient mice were allocated to orchiectomy and/or monthly injections with the GnRH receptor agonist leuprolide or the GnRH receptor antagonist degarelix. Atherosclerosis was quantified at 26 weeks of age in the aortic arch by en face examination and in the aortic root by histology. In intact Apoe-deficient mice, all types of ADT reduced testosterone production to castration levels. Although hypercholesterolemia was accentuated in leuprolide-treated mice, the amount and composition of atherosclerosis was not different between the different types of ADT. In orchiectomized Apoe-deficient mice, leuprolide, but not degarelix, augmented hypercholesterolemia, changed body, thymus, and spleen weights, and increased atherosclerosis in the aortic root. No direct effects of the drugs were detectable on cytokine secretion from murine bone marrow-derived macrophages or on splenocyte proliferation. CONCLUSIONS No differences in the development of atherosclerosis were detected among groups of intact Apoe-deficient mice treated with different types of ADT. A pro-atherogenic, possibly cholesterol-mediated, effect of leuprolide was seen in orchiectomized mice that might be relevant for understanding the potential cardiovascular risk associated with GnRH agonist-based ADT.
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Affiliation(s)
- Christian Bo Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Bødtker Mortensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Wolfgang Koechling
- Non-Clinical Development, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Charlotte Brandt Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Fog Bentzon
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
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Kang M, Lee HS, Lee YJ, Choi WS, Park YH, Jeong CW, Ku JH, Kim HH, Kwak C. S100A3 Suppression Inhibits In Vitro and In Vivo Tumor Growth and Invasion of Human Castration-resistant Prostate Cancer Cells. Urology 2015; 85:273.e9-15. [PMID: 25440760 DOI: 10.1016/j.urology.2014.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/27/2014] [Accepted: 09/16/2014] [Indexed: 01/24/2023]
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Hopmans SN, Duivenvoorden WC, Werstuck GH, Klotz L, Pinthus JH. GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model1Contributed equally and share first authorship. Urol Oncol 2014; 32:1126-34. [DOI: 10.1016/j.urolonc.2014.06.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
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Abstract
BACKGROUND The absence of evidence-based guidelines for prostate cancer treatment led the Institute of Medicine to include localized prostate cancer treatment among the 25 most important topics for comparative effectiveness research. OBJECTIVE This study compared prostate cancer treatment and survival in men with and without prevalent comorbid conditions. RESEARCH DESIGN The sample comprised elderly men, aged 66 years and older, extracted from SEER-Medicare data, between 2004 and 2009 (N=73,563). Treatment and survival for men with at least 1 of 4 prevalent comorbid conditions were compared with men who did not have any of the 12 Charlson comorbid conditions. The sample was stratified by comorbid condition and low-risk, intermediate-risk, and high-risk disease. RESULTS Over half of men received some form of cancer-directed treatment, irrespective of comorbid condition. Men who have congestive heart failure (CHF) or multiple comorbid conditions were less likely to be treated, whereas men with diabetes were more likely to be treated. With the exception of men with CHF, men with comorbid conditions and low-risk disease received no survival benefit from any type of treatment. CONCLUSIONS Most men received treatment, particularly radiation therapy, regardless of comorbid condition. The evidence suggests more caution should be used when treating men with low-risk disease and comorbid conditions as they are at risk for adverse events and additional medical costs, without a survival benefit.
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Huang J, Detterbeck FC, Wang Z, Loehrer PJ. [Standard outcome measures for thymic malignancies]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:122-9. [PMID: 24581163 PMCID: PMC6131238 DOI: 10.3779/j.issn.1009-3419.2014.02.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James Huang
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine and Department of Biostatistics, School of Epidemiology and Public Health, Yale University, New Haven, Connecticut
| | - Frank C Detterbeck
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Zuoheng Wang
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Patrick J Loehrer
- HH Gregg Professor of Oncology, Division of Medical Oncology, Department of Internal Medicine, Indiana Universitychool of Medicine, Indianapolis, Indiana
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Darwish-Yassine M, Berenji M, Wing D, Copeland G, Demers RY, Garlinghouse C, Fagerlin A, Newth GE, Northouse L, Holmes-Rovner M, Rovner D, Sims J, Wei JT. Evaluating long-term patient-centered outcomes following prostate cancer treatment: findings from the Michigan Prostate Cancer Survivor study. J Cancer Surviv 2013; 8:121-30. [PMID: 24214413 DOI: 10.1007/s11764-013-0312-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 09/24/2013] [Indexed: 02/02/2023]
Abstract
CONTEXT Advances in screening and treatment of prostate cancer have dramatically increased the number of survivors in the US population. Yet the effect of screening is controversial, and in some instances may not be beneficial. Previous studies have typically only reported outcomes of treatment and symptoms within a short time frame following treatment. The persistence of such symptoms over time necessitates an improvement of survivor care so that the medical and support needs of these patients are met. OBJECTIVE This study aims to perform a patient-centered survey of prostate cancer survivors in the Michigan Cancer Registry to identify treatment side effect rates, evaluate survivors' access to preventive care services post-prostate cancer treatment, and assess the informational needs of these survivors regarding their prostate cancer. DESIGN, SETTING, AND PATIENTS Linking case files of the Michigan Cancer Registry with records from the National Death Index, we identified prostate cancer patients diagnosed between 1985 and 2004 and alive on 31 December 2005. Participants were selected using a stratified cross-sectional sampling strategy to ensure adequate inclusion of survivors based upon race and ethnicity, urban versus rural location, and number of years since diagnosis of prostate cancer. A total of 2,499 surveys were completed and returned. MAIN OUTCOME MEASURES (1) Physical symptoms--assessing bowel, sexual, urinary, and vitality symptoms by treatment modality. (2) Access to care--identifying whether diagnostic tests for prostate cancer (prostate-specific antigen (PSA) and digital rectal examination) were performed. Determining whether the survivors had knowledge of the "watchful waiting" paradigm for prostate cancer surveillance. (3) Informational needs--assessing whether the informational needs of patients were addressed by providers. Evaluating the significant predictors associated with seeking information about prostate cancer from any other source. Identifying what factors influenced a person to actively seek out information and what factors guide which primary information source a survivor would use. RESULTS Median duration between prostate cancer diagnosis and survey response was 9 years. Of the study population, 80 % was diagnosed at an early stage. Survivors had reported significant problems in the 4 weeks prior to survey. Of the survivors, 88.1 % reported having a PSA test since diagnosis of prostate cancer, with 93 % of them having it done at least once per year. Of the survivors, 82.6 % reported that a healthcare provider gave them information on prostate cancer. Of this 82.6 %, 86.4 % had this information provided by a urologist, 45.4 % by a primary care physician, and 29.2 % by an oncologist. The primary source of information for these survivors was "healthcare provider" (59.2 %). CONCLUSION Persistent symptoms subsequent to prostate cancer treatment suggest a gap in symptom management. Future research should support long-term studies of active surveillance versus active treatment outcomes to understand the feasibility of minimizing the burden of long-term physical symptoms arising from prostate cancer treatment. Clinicians must assess post-treatment distress long after treatment has ended to identify when supportive care is needed. More informational resources should be allocated to prostate cancer survivors to ensure that they are well-educated about their prognosis. IMPLICATIONS FOR CANCER SURVIVORS This study is needed to ensure that the post-treatment symptoms of prostate cancer survivors are properly addressed and managed by healthcare providers over the long term.
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Affiliation(s)
- May Darwish-Yassine
- Cancer Control Services Program, Michigan Public Health Institute, Okemos, MI, USA
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Trost LW, Serefoglu E, Gokce A, Linder BJ, Sartor AO, Hellstrom WJG. Androgen deprivation therapy impact on quality of life and cardiovascular health, monitoring therapeutic replacement. J Sex Med 2013; 10 Suppl 1:84-101. [PMID: 23387914 DOI: 10.1111/jsm.12036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is commonly utilized in the management of both localized and advanced adenocarcinoma of the prostate. The use of ADT is associated with several adverse events, physical changes, and development of medical comorbidities/mortality. AIM The current article reviews known adverse events associated with ADT as well as treatment options, where available. Current recommendations and guidelines are cited for ongoing monitoring of patients receiving ADT. METHODS A PubMed search of topics relating to ADT and adverse outcomes was performed, with select articles highlighted and reviewed based on level of evidence and overall contribution. MAIN OUTCOME MEASURES Reported outcomes of studies detailing adverse effects of ADT were reviewed and discussed. Where available, randomized trials and meta-analyses were reported. RESULTS ADT may result in several adverse events including decreased libido, erectile dysfunction, vasomotor symptoms, cognitive, psychological and quality of life impairments, weight gain, sarcopenia, increased adiposity, gynecomastia, reduced penile/testicular size, hair changes, periodontal disease, osteoporosis, increased fracture risk, diabetes and insulin resistance, hyperlipidemia, and anemia. The definitive impact of ADT on lipid profiles, cardiovascular morbidity/mortality, and all-cause mortality is currently unknown with available data. Treatment options to reduce ADT-related adverse events include changing to an intermittent treatment schedule, biophysical therapy, counseling, and pharmacotherapy. CONCLUSIONS Patients treated with ADT are at increased risk of several adverse events and should be routinely monitored for the development of potentially significant morbidity/mortality. Where appropriate, physicians should reduce known risk factors and counsel patients as to known risks and benefits of therapy.
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Salvador C, Planas J, Agreda F, Placer J, Trilla E, Lopez M, Morote J. Analysis of the Lipid Profile and Atherogenic Risk during Androgen Deprivation Therapy in Prostate Cancer Patients. Urol Int 2013; 90:41-4. [DOI: 10.1159/000342814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/19/2012] [Indexed: 11/19/2022]
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Androgen deprivation by flutamide modulates uPAR, MMP-9 expressions, lipid profile, and oxidative stress: amelioration by daidzein. Mol Cell Biochem 2012; 374:49-59. [PMID: 23135684 DOI: 10.1007/s11010-012-1504-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
The growth and development of prostate gland is governed by testosterone. Testosterone helps in maintaining the adipose tissue stores of the body. It is well documented that with advancing age there has been a gradual decline in testosterone levels. Our aim was to study the protective role of daidzein on flutamide-induced androgen deprivation on matrix degrading genes, lipid profile and oxidative stress in Wistar rats. Sub-chronic (60 days) flutamide (30 mg/kg b.wt) administration resulted in marked increase in expressions of matrix degrading genes [matrix metalloproteases 9 and urokinase plasminogen activation receptor]. Additionally, it increased the levels of low density lipoproteins, total cholesterol, triglycerides, and lowered the levels of high density lipoproteins and endogenous antioxidant levels. Oral administration of daidzein (20 and 60 mg/kg b.wt) restituted the levels to normal. Daidzein administration resulted in amelioration of the prostate atrophy, degeneracy and invasiveness induced by flutamide. Our findings suggest that the daidzein may be given as dietary supplement to patients who are on androgen deprivation therapy, to minimize the adverse effects related to it and also retarding susceptibility of patients to cardiovascular diseases.
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Abstract
Metabolic disorders such as diabetes, obesity and the metabolic syndrome have been shown to modulate prostate cancer (PCa) risk and aggressiveness in population-based and experimental studies. While associations between these conditions are modest and complex, two consistent findings have emerged. First, there is observational evidence that obesity and associated insulin excess are linked to increased PCa aggressiveness and worse outcomes. Secondly and somewhat paradoxically, long-standing diabetes may be protective against PCa development. This apparent paradox may be due to the fact that long-standing diabetes is associated with insulin depletion and decreased IGF1 signalling. Men with obesity or diabetes have moderate reductions in their androgen levels. The interconnectedness of metabolic and androgen status complicates the dissection of the individual roles of these factors in PCa development and progression. Metabolic factors and androgens may promote prostate carcinogenesis via multiple mechanisms including inflammation, adipokine action, fatty acid metabolism and IGF signalling. Moreover, androgen deprivation, given to men with PCa, has adverse metabolic consequences that need to be taken into account when estimating the risk benefit ratio of this therapy. In this review, we will discuss the current epidemiological and mechanistic evidence regarding the interactions between metabolic conditions, sex steroids and PCa risk and management.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
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Eifler JB, Humphreys EB, Agro M, Partin AW, Trock BJ, Han M. Causes of Death After Radical Prostatectomy at a Large Tertiary Center. J Urol 2012; 188:798-801. [DOI: 10.1016/j.juro.2012.04.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Indexed: 11/25/2022]
Affiliation(s)
- John Bernard Eifler
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Elizabeth B. Humphreys
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Marilyn Agro
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alan W. Partin
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Bruce J. Trock
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Misop Han
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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The current practice of screening, prevention, and treatment of androgen-deprivation-therapy induced osteoporosis in patients with prostate cancer. JOURNAL OF ONCOLOGY 2012; 2012:958596. [PMID: 22619678 PMCID: PMC3350851 DOI: 10.1155/2012/958596] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/14/2012] [Indexed: 11/17/2022]
Abstract
Introduction. ADT is used in the management of locally advanced and metastatic disease. The detrimental effect of ADT on bone density is well documented. This study assesses care gaps in screening, prevention and treatment of osteoporosis among prostate cancer patients. Methods. We conducted a retrospective cohort study for patients diagnosed with non-metastatic prostate cancer on ADT. Charts from a tertiary oncology center were assessed for utilization of DXA scan, prescription of calcium, vitamin D, calcitonin and bisphosphonates.Bivariate analysis was used to determine the effect of patient characteristics and likelihood for osteoporosis screening. Results. 149 charts were reviewed, with 3-year mean follow-up. 58.8% of men received a baseline DXA, of which 20.3% had a repeat DXA within their follow-up periods.In all, 28% were appropriately screened and managed for osteoporosis (received repeat DXA, bisphosphonate). In bivariate analysis, the number of ADT injections which correlate with the duration of androgen suppression was significantly associated with the number of DXA scans. Conclusions. Our study found a care gap in the screening, prevention, and treatment of osteoporosis in this population. Patients receiving the most ADT injections were more likely to be screened. Our results suggest healthcare providers treating prostate cancer are insufficiently screening and treating this susceptible population. We suggest baseline measurement of BMD at the initiation of ADT with periodic reassessment during therapy.
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Salvador C, Planas J, Raventós C, Ropero J, Placer J, López M, Morote J. [Impact of androgen deprivation on the lipid profile and atherogenic risk in prostate cancer patients]. Actas Urol Esp 2012; 36:205-9. [PMID: 22178349 DOI: 10.1016/j.acuro.2011.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 09/19/2011] [Accepted: 09/29/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study has aimed to analyze the changes observed in the lipid profile and atherogenic risk in prostate cancer patients subjected to androgen deprivation. MATERIAL AND METHODS Between 2001 and 2008, serum lipoproteins (total cholesterol, HDL, LDL and triglycerides) were determined in 636 patients. Of these, 129 were treated with maximum androgen blockade and 177 patients were only treated with LHRH analogue. The control group was formed by 339 subjected to prostate biopsy (212 with prostate cancer and 127 without prostate cancer). The atherogenic risk was calculated using the Castelli formula (total cholesterol/HDL). RESULTS Mean atherogenic risk was 4.2 in the control group and 4 in the group of patients subjected to androgenic deprivation, p>0.05. The mean atherogenic risk in those subjected to monotherapy with LHRH analogues was 4.1 while it was 3.9 in patients subjected to maximal androgen blockade, p=0.02. We did not found significant differences for atherogenic risk according to length of treatment, p>0.05. The multivariate analysis confirmed that the treatment modality was the only significant variable influencing atherogenic risk. CONCLUSIONS This study demonstrates that continuous androgen deprivation does not increase atherogenic risk in patients with prostate cancer. This risk also did not increase during the treatment. The association of bicalutamide to the LHRH analogue seems to have a protective effect on atherogenic risk.
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Rink M, Fajkovic H, Cha EK, Gupta A, Karakiewicz PI, Chun FK, Lotan Y, Shariat SF. Death Certificates Are Valid for the Determination of Cause of Death in Patients With Upper and Lower Tract Urothelial Carcinoma. Eur Urol 2012; 61:854-5. [DOI: 10.1016/j.eururo.2011.12.055] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Collins L, Mohammed N, Ahmad T, Basaria S. Androgen deprivation therapy for prostate cancer: implications for cardiometabolic clinical care. J Endocrinol Invest 2012; 35:332-9. [PMID: 22391014 DOI: 10.3275/8284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Prostate cancer (PCa) is the most common malignancy in men. Androgen deprivation therapy (ADT) plays an important role in the management of locally advanced and metastatic PCa. Its use in combination with external beam radiation and as an adjuvant therapy has resulted in improved survival in a subset of patients with locally advanced disease. In men with metastatic disease, ADT results in improvement in pain and overall quality of life. In addition to these two clinical settings where ADT has proven benefits, it is also being increasingly used in patients experiencing biochemical recurrence and those with early stage localized disease, even though no survival advantage has been demonstrated. ADT has significant adverse effects such as sexual dysfunction, decreased lean mass, increased fat mass, decreased quality of life, anemia, and osteoporosis. Recently, insulin resistance, diabetes, and metabolic syndrome have emerged as complications of ADT. Some data also suggests that ADT might be responsible for incident cardiovascular disease. Since the majority of men with PCa die of conditions other than their malignancy, recognition and management of these adverse effects is important. This paper serves as a focused review of recent studies examining the metabolic abnormalities and cardiovascular disease related to ADT.
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Affiliation(s)
- L Collins
- Boston University Medical Center, Boston, MA, USA
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Rowlands MA, Holly JMP, Hamdy F, Phillips J, Goodwin L, Marsden G, Gunnell D, Donovan J, Neal DE, Martin RM. Serum insulin-like growth factors and mortality in localised and advanced clinically detected prostate cancer. Cancer Causes Control 2011; 23:347-54. [PMID: 22183619 DOI: 10.1007/s10552-011-9883-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 12/05/2011] [Indexed: 12/14/2022]
Abstract
CONTEXT Many studies have reported associations of insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) with prostate cancer development, but none have investigated their association with fatal progression of prostate cancer. OBJECTIVE We investigated associations of circulating IGF-I, IGF-II, IGFBP-2 and IGFBP-3 with all-cause and prostate cancer mortality in men with clinically identified prostate cancer, stratified by whether localised (stage T1 or T2) or advanced (T3, T4, N1 or M1) at diagnosis. DESIGN, SETTING AND PARTICIPANTS UK hospital-based cohort study of 396 men with prostate cancer, diagnosed between 1990 and 2008, with mean follow-up of 3.7 years. MAIN OUTCOME MEASURES All-cause and prostate cancer-specific mortality. RESULTS In men with advanced cancer, there was some evidence that IGF-I was positively associated (HR 1.20; 95% CI: 0.96, 1.49; p = 0.11) and IGFBP-3 was inversely associated (HR 0.84; 95% CI: 0.70, 1.01; p = 0.07) with all-cause mortality after controlling for age, treatment status, smoking, prostate-specific antigen and Gleason grade at diagnosis. There was some evidence that IGF-I was positively associated with prostate cancer mortality in advanced cases (HR 1.23; 95% CI: 0.94, 1.62; p = 0.13). In advanced cancers, associations of IGF-I with all-cause (HR 1.68; 95% CI: 1.28, 2.23; p < 0.001) and prostate cancer-specific (HR 1.59; 95% CI: 1.11, 2.28; p = 0.01) mortality strengthened (and were conventionally statistically significant) after further controlling for IGFBP-3. CONCLUSIONS Measures of IGF-I and IGFBP-3 may have potential as prognostic markers in predicting risk of death in men with advanced prostate cancer. Large, prospective studies with repeat IGFs and IGFBPs are now required.
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Affiliation(s)
- Mari-Anne Rowlands
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Shikanov S, Kocherginsky M, Shalhav AL, Eggener SE. Cause-specific mortality following radical prostatectomy. Prostate Cancer Prostatic Dis 2011; 15:106-10. [PMID: 22083265 DOI: 10.1038/pcan.2011.55] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND To evaluate cause-specific mortality following radical prostatectomy (RP) in a population cohort of US men adjusting for competing risks. METHODS The Surveillance, Epidemiology and End Results (SEER) database was used to identify 120,392 men undergoing RP for clinically localized prostate cancer between 1988 and 2003. Cause-specific mortality data were extracted through 2006 and cumulative incidence was estimated using a competing risks approach. RESULTS The stage distribution of the cancers was 32% local, 28% regional, 40% unknown, and 80% of tumors Gleason ≤ 7. Median follow-up was 7 years. The 15-year prostate cancer-specific mortality was 5.3% and the non-prostate cancer mortality was 30.6%. Stage, grade and race had minimal impact on non-prostate cancer mortality. At 15 years following surgery, mortality due to cardiovascular diseases was 11%, other cancers 9.1%, and other causes 10.5%. Among men ≥ 65 years, 15-year cancer-specific mortality was 6% and non-prostate cancer mortality was 40.8%. CONCLUSIONS Following RP, death from cardiovascular diseases, other cancers, and other causes is far more common than death from prostate cancer. In men diagnosed with prostate cancer, significant efforts should be made to prevent, diagnose, and treat these diseases.
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Affiliation(s)
- S Shikanov
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
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Nobes JP, Langley SEM, Klopper T, Russell-Jones D, Laing RW. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU Int 2011; 109:1495-502. [PMID: 21933330 DOI: 10.1111/j.1464-410x.2011.10555.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Study Type - Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Men with prostate cancer have higher rates of non-cancer mortality and CV morbidity and some of that excess risk has been attributed to the treatment they receive. ADT is an established treatment option for men with locally-advanced and metastatic prostate cancer and, although it has been shown to confer a disease-free survival advantage, it has also been associated with an increased incidence of CV disease and the metabolic syndrome (characterized by a cluster of CV risk factors, including insulin resistance). The benefits of the insulin sensitizer metformin and lifestyle intervention for reducing the incidence of metabolic syndrome have been shown in patients with impaired glucose tolerance. At the time of writing, the present study is the first to use metformin and lifestyle intervention in men with prostate cancer with the aim of reducing the risk of developing ADT-related CV morbidity and the metabolic syndrome. The study shows that lifestyle changes and metformin may indeed reduce the complications of androgen suppression in these men. Although further investigations are needed to establish which of the two interventions may be most beneficial, the favourable effects of a combination of these interventions on patients' quality of life and the potential for improved overall survival are of clinical significance. OBJECTIVE To investigate the effects of metformin and lifestyle changes on the development of androgen deprivation therapy (ADT)-related metabolic syndrome. PATIENTS AND METHODS Men with prostate cancer due to receive ADT were recruited and randomized. Controls received ADT alone. Men in the intervention arm received ADT with 6 months of metformin, a low glycaemic index diet and an exercise programme. All patients were investigated pretreatment and at 6 months for the metabolic syndrome, as well as for related biochemical and physical parameters. RESULTS In total, 40 men were recruited and randomized (20 to each arm). After 6 months, significant improvements in abdominal girth (P= 0.05), weight (P < 0.001), body mass index (P < 0.001) and systolic blood pressure (P= 0.01) were seen in the intervention arm compared to controls. Biochemical markers of insulin resistance did not differ significantly. CONCLUSIONS The present study shows the potential benefits of metformin and lifestyle changes in ADT-treated men. Further studies will aim to determine which intervention is most important, and may show that overall survival can be improved.
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Affiliation(s)
- Jenny P Nobes
- Department of Diabetes and Endocrinology, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Grossmann M, Zajac JD. Management of side effects of androgen deprivation therapy. Endocrinol Metab Clin North Am 2011; 40:655-71, x. [PMID: 21889727 DOI: 10.1016/j.ecl.2011.05.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Androgen deprivation therapy (ADT) is a major component of the contemporary management of prostate cancer. ADT's use is increasing rapidly. The side effects of this therapy include loss of bone mass and fractures, increase in fat mass, and worsening of insulin resistance, the metabolic syndrome, diabetes and cardiovascular risk, and anemia and loss of muscle. Neuropsychological and sexual symptoms are common. The impact of these side effects is often overlooked or underestimated in decisions about prostate cancer therapy. This review surveys the data relating to the side effects of ADT and provides recommendations regarding their minimization and management.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine Austin Health/Northern Health, University of Melbourne, Heidelberg, Victoria 3084, Australia
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Metabolic complications and increased cardiovascular risks as a result of androgen deprivation therapy in men with prostate cancer. Prostate Cancer 2011; 2011:391576. [PMID: 22110984 PMCID: PMC3200266 DOI: 10.1155/2011/391576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/04/2011] [Accepted: 05/06/2011] [Indexed: 02/02/2023] Open
Abstract
Prostate cancer is one of the most common malignancies in men. Charles Huggins and Clarence V. Hodges reported the androgen dependence of prostate cancer in 1941. That led to the utilization of androgen deprivation therapy as an important therapeutic modality to treat prostate cancer. Androgen deprivation therapy has additional systemic effects that include sexual dysfunction, psychological changes and more important are the metabolic changes. Metabolic changes in particular include insulin resistance, increase fat mass and low-density lipoprotein cholesterol, and induce type 2 diabetes. In this review we will focus on the cardiovascular risk associated with androgen deprivation therapy that includes the mechanisms involved.
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Bittner N, Merrick GS, Galbreath RW, Butler WM, Lief JH, Allen ZA, Wallner KE. Erectile dysfunction is predictive of all-cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy. BJU Int 2011; 109:220-5. [DOI: 10.1111/j.1464-410x.2011.10280.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sajid S, Mohile SG, Szmulewitz R, Posadas E, Dale W. Individualized decision-making for older men with prostate cancer: balancing cancer control with treatment consequences across the clinical spectrum. Semin Oncol 2011; 38:309-25. [PMID: 21421119 DOI: 10.1053/j.seminoncol.2011.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Prostate cancer (PCa) is the most prevalent non-skin cancer among men and is the second leading cause of cancer death in men. PCa has an increased incidence and prevalence in older men. Age-associated incidence is on the rise due to increased screening in the older population. This has led to a sharp rise in the detection of early stage PCa. Given the indolent nature of many prostatic malignancies, a large proportion of older men with PCa will ultimately die from other causes. As a result, physicians and patients are faced with the challenge of identifying optimal treatment strategies for localized PCa, biochemically recurrent PCa and later-stage PCa. Age-related changes can impact tolerance of hormonal therapy and chemotherapy in men with metastatic disease and shift the risk-benefit ratio of these treatments. Tools such as the Comprehensive Geriatric Assessment (CGA) can help estimate remaining life expectancy and can help predict treatment-related morbidity and mortality in older men. Application of CGA in older men with PCa is important to help individualize and optimize treatment strategies. Research that integrates multidisciplinary and multidimensional assessment of PCa and the patient's overall health status is needed.
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Affiliation(s)
- Saleha Sajid
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
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Godtman R, Holmberg E, Stranne J, Hugosson J. High accuracy of Swedish death certificates in men participating in screening for prostate cancer: A comparative study of official death certificates with a cause of death committee using a standardized algorithm. ACTA ACUST UNITED AC 2011; 45:226-32. [DOI: 10.3109/00365599.2011.559950] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences,
Sahlgrenska Academy at University of Göteborg, Sweden
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Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular. Aten Primaria 2011; 43:197-201. [DOI: 10.1016/j.aprim.2010.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/12/2010] [Accepted: 04/12/2010] [Indexed: 11/23/2022] Open
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Abstract
Thymic malignancies present particular issues due to the pace of disease progression, patterns of recurrence, and causes of death that make nuances of how outcomes are reported particularly important. The relatively limited number of patients also creates a challenge to glean as much as possible from the available experience, but risks over-interpretation and potentially misleading conclusions. Therefore the International Thymic Malignancy Interest Group has developed a set of standards for reporting of outcome measures of clinical studies, which have been adopted for collaborative projects undertaken by the organization. Widespread adoption of this baseline will enhance the ability to compare results from different series.
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Grossmann M, Hamilton EJ, Gilfillan C, Bolton D, Joon DL, Zajac JD. Bone and metabolic health in patients with non‐metastatic prostate cancer who are receiving androgen deprivation therapy. Med J Aust 2011; 194:301-6. [DOI: 10.5694/j.1326-5377.2011.tb02979.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 08/18/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Mathis Grossmann
- Austin Health/Northern Health, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | - Emma J Hamilton
- Austin Health/Northern Health, University of Melbourne, Melbourne, VIC
- Department of Endocrinology and Diabetes, Fremantle Hospital and Health Service, Fremantle, WA
| | | | - Damien Bolton
- Austin Health/Northern Health, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | | | - Jeffrey D Zajac
- Austin Health/Northern Health, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
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